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Weber I, Zagona-Prizio C, Sivesind TE, Adelman M, Szeto MD, Liu Y, Sillau SH, Bainbridge J, Klawitter J, Sempio C, Dunnick CA, Leehey MA, Dellavalle RP. Oral Cannabidiol for Seborrheic Dermatitis in Patients With Parkinson Disease: Randomized Clinical Trial. JMIR Dermatol 2024; 7:e49965. [PMID: 38466972 DOI: 10.2196/49965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Seborrheic dermatitis (SD) affects 18.6%-59% of persons with Parkinson disease (PD), and recent studies provide evidence that oral cannabidiol (CBD) therapy could reduce sebum production in addition to improving motor and psychiatric symptoms in PD. Therefore, oral CBD could be useful for improving symptoms of both commonly co-occurring conditions. OBJECTIVE This study investigates whether oral CBD therapy is associated with a decrease in SD severity in PD. METHODS Facial photographs were collected as a component of a randomized (1:1 CBD vs placebo), parallel, double-blind, placebo-controlled trial assessing the efficacy of a short-term 2.5 mg per kg per day oral sesame solution CBD-rich cannabis extract (formulated to 100 mg/mL CBD and 3.3 mg/mL THC) for reducing motor symptoms in PD. Participants took 1.25 mg per kg per day each morning for 4 ±1 days and then twice daily for 10 ±4 days. Reviewers analyzed the photographs independently and provided a severity ranking based on the Seborrheic Dermatitis Area and Severity Index (SEDASI) scale. Baseline demographic and disease characteristics, as well as posttreatment SEDASI averages and the presence of SD, were analyzed with 2-tailed t tests and Pearson χ2 tests. SEDASI was analyzed with longitudinal regression, and SD was analyzed with generalized estimating equations. RESULTS A total of 27 participants received a placebo and 26 received CBD for 16 days. SD severity was low in both groups at baseline, and there was no treatment effect. The risk ratio for patients receiving CBD, post versus pre, was 0.69 (95% CI 0.41-1.18; P=.15), compared to 1.20 (95% CI 0.88-1.65; P=.26) for the patients receiving the placebo. The within-group pre-post change was not statistically significant for either group, but they differed from each other (P=.07) because there was an estimated improvement for the CBD group and an estimated worsening for the placebo group. CONCLUSIONS This study does not provide solid evidence that oral CBD therapy reduces the presence of SD among patients with PD. While this study was sufficiently powered to detect the primary outcome (efficacy of CBD on PD motor symptoms), it was underpowered for the secondary outcomes of detecting changes in the presence and severity of SD. Multiple mechanisms exist through which CBD can exert beneficial effects on SD pathogenesis. Larger studies, including participants with increased disease severity and longer treatment periods, may better elucidate treatment effects and are needed to determine CBD's true efficacy for affecting SD severity. TRIAL REGISTRATION ClinicalTrials.gov NCT03582137; https://clinicaltrials.gov/ct2/show/NCT03582137.
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Affiliation(s)
- Isaac Weber
- Mercy Hopsital St. Louis, St. Louis, MO, United States
| | - Caterina Zagona-Prizio
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Madeline Adelman
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ying Liu
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jacquelyn Bainbridge
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jost Klawitter
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cristina Sempio
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Maureen A Leehey
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Colorado School of Public Health, Aurora, CO, United States
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2
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Reeder MJ, Nihal A, Aravamuthan SR, Warshaw EM, DeKoven JG, Atwater AR, Houle MC, Adler BL, Silverberg JI, Taylor JS, Pratt MD, Belsito DV, Yu J, Botto NB, Mowad CM, Dunnick CA, DeLeo VA. Allergic or Not: Final Interpretation of Doubtful Patch Test Reactions From the North American Contact Dermatitis Group, 2019-2020. Dermatitis 2024; 35:138-143. [PMID: 38320244 DOI: 10.1089/derm.2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background: Doubtful patch test reactions generally do not meet criterion for positivity in patch testing. However, the North American Contact Dermatitis Group (NACDG) allows for doubtful reactions to be coded with a final determination of "allergic/positive" based on the temporal pattern, appearance, known characteristics of the allergen, and/or other supportive patch test reactions. Objectives: To analyze NACDG data from the 2019-2020 patch test cycle to identify patterns in the interpretation and relevance of doubtful reactions. Methods: The frequency and proportions of doubtful reactions were tabulated and analyzed for patterns. Statistical analyses were limited to allergens with ≥30 doubtful reactions to ensure adequate sample size. Results: Of patch-tested patients, 31.9% (1315/4121) had ≥1 doubtful reaction. Of 2538 total doubtful reactions, 46% (n = 1167) had a final interpretation of "allergic/positive." The allergens with the highest proportion of doubtful reactions at the final visit were hydroperoxides of linalool 1% (4.5%), fragrance mix I 8.0% (3.9%), and cetrimonium chloride 0.5% (3.4%). Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) 0.02% (P < 0.001), MI 0.2% (P < 0.001), nickel sulfate hexahydrate 2.5% (P = 0.001), and neomycin sulfate 20.0% (P = 0.003) doubtful reactions were more likely to be interpreted as allergic than nonallergic. Methyldibromoglutaronitrile/phenoxyethanol 0.2% (P < 0.001), oleamidopropyl dimethylamine 0.1% (P < 0.001), formaldehyde 2.0% (P < 0.001), cetrimonium chloride 0.5% (P < 0.001), benzophenone-4 (sulisobenzone) 10% (P < 0.001), iodopropynyl butylcarbamate 0.5% (P < 0.001), cocamidopropyl betaine 1.0% (P = 0.002), and benzisothiazolinone 0.1% (P = 0.012) doubtful reactions were less likely to be interpreted as allergic. Of the 1167 doubtful reactions interpreted as allergic, 84.9% had current relevance. Conclusions: Doubtful reactions were common and approximately one half were coded with a final interpretation of "allergic/positive." Of those, most were clinically relevant. MCI/MI, MI, nickel, and neomycin were more likely to be interpreted as allergic.
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Affiliation(s)
- Margo J Reeder
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Aman Nihal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Srikanth R Aravamuthan
- From the Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina B Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; and
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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3
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Reeder MJ, Zhang D, Aravamuthan SR, Warshaw EM, DeKoven JG, Silverberg JI, Adler BL, Atwater AR, Taylor JS, Houle MC, Belsito DV, Yu J, Botto N, Mowad CM, Dunnick CA, DeLeo VA, Pratt MD. More than just methylisothiazolinone: Retrospective analysis of patients with isothiazolinone allergy in North America, 2017-2020. J Am Acad Dermatol 2024; 90:319-327. [PMID: 37879460 DOI: 10.1016/j.jaad.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Isothiazolinones are a common cause of allergic contact dermatitis. OBJECTIVE To examine the prevalence of positive patch test reactions to isothiazolinones from 2017-2020 and characterize isothiazolinone-allergic (Is+) patients compared with isothiazolinone nonallergic (Is-) patients. METHODS Retrospective cross-sectional analysis of 9028 patients patch tested to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) 0.02% aqueous, MI 0.2% aqueous, benzisothiazolinone (BIT) 0.1% petrolatum, and/or octylisothiazolinone (OIT) 0.025% petrolatum. Prevalence, reaction strength, concurrent reactions, clinical relevance, and source of allergens were tabulated. RESULTS In total, 21.9% (1976/9028) of patients had a positive reaction to 1 or more isothiazolinones. Positivity to MI was 14.4% (1296/9012), MCI/MI was 10.0% (903/9017), BIT was 8.6% (777/9018), and OIT was 05% (49/9028). Compared with Is-, Is+ patients were more likely to have occupational skin disease (16.5% vs 10.3%, P <.001), primary hand dermatitis (30.2% vs 19.7%, P <.001), and be >40 years (73.1% vs 61.9%, P <.001). Positive patch test reactions to >1 isothiazolinone occurred in 44.1% (871/1976) of Is+ patients. Testing solely to MCI/MI would miss 47.3% (611/1292) of MI and 60.1% (466/776) of BIT allergic reactions. LIMITATIONS Retrospective cross-sectional study design and lack of follow-up data. CONCLUSION Sensitization to isothiazolinones is high and concurrent sensitization to multiple isothiazolinone allergens is common.
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Affiliation(s)
- Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Donglin Zhang
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Srikanth R Aravamuthan
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Botto
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Christen M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Canada
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4
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Warshaw EM, Han J, Kullberg SA, DeKoven JG, Adler BL, Silverberg JI, Houle MC, Pratt MD, Belsito DV, Yu J, Botto NC, Reeder MJ, Taylor JS, Atwater AR, Dunnick CA, DeLeo VA, Mowad CM. Patch Testing to Chlorhexidine Digluconate, 1% Aqueous: North American Contact Dermatitis Group Experience, 2015-2020. Dermatitis 2023; 34:501-508. [PMID: 37279017 DOI: 10.1089/derm.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background: Chlorhexidine is an antiseptic that may cause allergic contact dermatitis. Objectives: To describe the epidemiology of chlorhexidine allergy and characterize positive patch test reactions. Methods: This retrospective study analyzed patients patch tested to chlorhexidine digluconate 1% aqueous by the North American Contact Dermatitis Group, 2015-2020. Results: Of 14,731 patients tested to chlorhexidine digluconate, 107 (0.7%) had an allergic reaction; of these, 56 (52.3%) reactions were currently clinically relevant. Most (59%) reactions were mild (+), followed by strong (++, 18.7%) and very strong (+++, 6.5%). Common primary dermatitis anatomic sites in chlorhexidine-positive patients were hands (26.4%), face (24.5%), and scattered/generalized distribution (17.9%). Compared with negative patients, chlorhexidine-positive patients were significantly more likely to have dermatitis involving the trunk (11.3% vs 5.1%; P = 0.0036). The most commonly identified source category was skin/health care products (n = 41, 38.3%). Only 11 (10.3%) chlorhexidine reactions were occupationally related; of these, 81.8% were in health care workers. Conclusions: Chlorhexidine digluconate allergy is uncommon, but often clinically relevant. Involvement of the hands, face, and scattered generalized patterns was frequent. Occupationally related reactions were found predominantly in health care workers.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joohee Han
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
| | - Sara A Kullberg
- From the Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nina C Botto
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Chris M Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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5
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Warshaw EM, Peterson MY, Atwater AR, DeKoven JG, Pratt MD, Taylor JS, Belsito DV, Silverberg JI, Reeder MJ, DeLeo VA, Houle MC, Dunnick CA, Yu J, Adler B, Mowad C, Botto NC. Patch Testing to Paraphenylenediamine: The North American Contact Dermatitis Group Experience (1994-2018). Dermatitis 2023; 34:536-546. [PMID: 37523239 DOI: 10.1089/derm.2023.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Background/Objectives: Paraphenylenediamine (PPD) is an aromatic amine dye that may cause allergic contact dermatitis. This study examines the epidemiology of allergic patch test reactions to PPD. Methods: This retrospective analysis characterizes individuals tested to PPD (1% petrolatum) by the North American Contact Dermatitis Group (1994-2018). Demographics and dermatitis site(s) were compared between PPD-allergic and PPD-negative patients. PPD reactions were analyzed by reaction strength, clinical relevance, occupational relatedness, and source as well as coreactivity with structurally related compounds. Results: Of 54,917 patients tested to PPD, 3095 (5.6%) had an allergic patch test reaction. Compared with PPD-negative patients, PPD-allergic patients had significantly greater odds of age >40 years (odds ratio [OR] 1.55 [95% confidence interval; CI 1.43-1.69]) and female gender (OR 1.52 [95% CI 1.41-1.66]), but lower odds of being White (OR 0.66 [95% CI 0.60-0.71]). The most common primary anatomic sites of dermatitis were face (25.5%), hands (21.9%), and scattered/generalized pattern (15.5%). Over half (55.3%) of PPD reactions were ++ or +++ at the final reading and 60.9% were currently relevant. Common exposure sources included hair dye (73.5%) and clothing/shoes/apparel (3.9%). Occupationally related reactions occurred in 8.3%, most commonly in hairdressers/cosmetologists (72.8%). The most common coreactions were benzocaine (11.3%), N-isopropyl-N'-phenyl-p-phenylenediamine (6.7%), disperse dye mix (6.5%), and black rubber mix (5.1%). Conclusions: The 24-year percentage of allergic reactions to PPD was 5.6%. PPD allergy was associated with female gender and age >40 years. PPD allergic patients were less likely to be White. Allergic reactions were usually clinically relevant and hair dye was the most frequently identified source.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Malina Yamashita Peterson
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brandon Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Christen Mowad
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Nina C Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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6
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Yu J, Johnson H, DeKoven JG, Warshaw EM, Taylor JS, Belsito DV, Adler BL, Silverberg JI, Atwater AR, Reeder MJ, Botto N, Houle MC, Mowad CM, Pratt MD, Dunnick CA. Patch Test Results Among Older Adults: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2009-2020). Dermatitis 2023. [PMID: 37590477 DOI: 10.1089/derm.2023.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Background: Allergic contact dermatitis (ACD) in older adults (OA) represents a significant health burden, but few studies examine the prevalence and characteristics of contact allergy and ACD in this population. Objective: To compare positive and clinically relevant patch test results in OA versus younger adults (YA) and children. Methods: Retrospective analysis of patch test results obtained in OA (≥65 years), YA (19-64 years), and children (≤18 years) by the North American Contact Dermatitis Group, 2009 to 2020. Results: Of 28,177 patients patch tested, 5366 (19.0%) were OA. OA were more likely to have a final primary diagnosis of ACD as compared with YA (50.8% vs 49.2%, P = 0.035) and children (44.6%, P < 0.0001). The primary site of dermatitis also differed by age group, with OA having a higher proportion of dermatitis affecting the trunk, scalp, anogenital region, and "under clothing," and a lower proportion of dermatitis affecting the face, lips, and feet. Limitations: Retrospective design, lack of follow-up, and referral population. Conclusion: OA were as likely and were statistically even more likely to have a final primary diagnosis of ACD compared with YA and children. Anatomic site of dermatitis also differed by age group. This underscores the need for patch testing in OA when ACD is suspected.
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Affiliation(s)
- JiaDe Yu
- From the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hadley Johnson
- From the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical College, New York, New York, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada; and
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
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7
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Mounessa J, Caravaglio JV, Domozych R, Chapman S, Dellavalle RP, Dunnick CA, Norris D. Commonly prescribed medications associated with alopecia. J Am Acad Dermatol 2023; 88:1326-1337.e2. [PMID: 37268392 DOI: 10.1016/j.jaad.2017.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 06/04/2023]
Abstract
BACKGROUND The diagnosis and treatment of medication-associated alopecia often challenges patients and physicians. While numerous studies on the topic exist, limited information on the strength and magnitude of these studies exists. OBJECTIVES We investigated the most commonly prescribed medications with high levels of evidence to support associations with alopecia. METHODS A list of most commonly prescribed medications was compiled using the "Top 100 Prescriptions, Sales" (Intercontinental Marketing Services) and "Top 200 Names Searched" (RxList.com). PubMed, Embase, and Web of Science were searched for "generic drug name" AND "alopecia" and "generic drug name" AND "hair loss." Two reviewers independently reviewed articles for drug, study type and level of evidence, and number of alopecia cases. RESULTS A total of 192 unique drugs were investigated, with 110 yielding positive search results. Of these, 13 were associated with alopecia in studies with strong levels of evidence (adalimumab, infliximab, budesonide, interferon β-1α, tacrolimus, enoxaparin, zoster vaccine, lamotrigine, docetaxel, capecitabine, erlotinib, imatinib, and bortezomib). LIMITATIONS Only full-length articles available in the English language were included. The methodology used relied on lists of drugs based on their sales rather than number of prescriptions, which likely overrepresented expensive drugs. CONCLUSIONS Few studies with high levels of evidence have been conducted on the topic of medication-associated alopecia. The mechanisms of hair loss must be further identified to provide effective management.
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Affiliation(s)
- Jessica Mounessa
- Stony Brook University School of Medicine, Stony Brook, New York; Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Renee Domozych
- University of Central Florida College of Medicine, Orlando, Florida
| | - Stephanie Chapman
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cory A Dunnick
- Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Norris
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.
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DeKoven JG, Warshaw EM, Reeder MJ, Atwater AR, Silverberg JI, Belsito DV, Sasseville D, Zug KA, Taylor JS, Pratt MD, Maibach HI, Fowler JF, Adler BL, Houle MC, Mowad CM, Botto N, Yu J, Dunnick CA. North American Contact Dermatitis Group Patch Test Results: 2019-2020. Dermatitis 2023; 34:90-104. [PMID: 36917520 DOI: 10.1089/derm.2022.29017.jdk] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Patch testing is an important diagnostic tool for assessment of allergic contact dermatitis (ACD). Objective: This study documents the North American Contact Dermatitis Group (NACDG) patch testing results from January 1, 2019, to December 31, 2020. Methods: At 13 centers in North America, patients were tested in a standardized manner with a screening series of 80 allergens, and, as indicated, supplemental allergens. Results: Overall, 4121 patients were tested; 2871 (69.7%) had at least 1 positive/allergic patch test reaction and 2095 patients (51.2%) had a primary diagnosis of ACD. The most commonly positive allergens were nickel (18.2%), methylisothiazolinone (MI) (13.8%), fragrance mix (FM) I (12.8%), hydroperoxides of linalool (HPL) (11.1%), and benzisothiazolinone (BIT) (10.4%). Compared with that of 2017-2018, prevalence of top 20 allergens statistically increased for FM I, HPL, BIT, propolis, and hydroperoxides of limonene (3.5%). For the first time, MI positivity did not increase between reporting periods. Approximately one-fifth of patients (20.3%) had ≥1 clinically relevant reaction(s) to allergens/substances not on the NACDG series. Conclusions: The epidemic of MI contact allergy in North America may have reached a plateau. Patch testing using a robust screening series, and supplemental allergens as indicated, is necessary for comprehensive evaluation of ACD.
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Affiliation(s)
- Joel G DeKoven
- From the *Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Division of Occupational Health, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical College, New York, New York, USA
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montréal, Canada
| | - Kathryn A Zug
- Department of Dermatology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, Nebraska, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
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9
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Warshaw EM, Xiong M, Belsito DV, Adler BL, Atwater AR, DeKoven JG, Taylor JS, Reeder MJ, Houle MC, Silverberg JI, Pratt MD, Dunnick CA, Botto N, DeLeo VA, Mowad CM, Maibach HI, Yu J, Fowler JF. Patch Testing With Benzophenone-3 and -4: The North American Contact Dermatitis Group Experience, 2013-2020. Dermatitis 2023; 34:105-112. [PMID: 36917534 DOI: 10.1089/derm.2022.29013.ewa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Benzophenone (BZP)-3 and BZP-4 are ultraviolet (UV) absorbers used in sunscreens and personal care products (PCPs) and may cause allergic contact dermatitis. Objective: To characterize positive patch test reactions to BZP-3 (10% in petrolatum [pet]) and BZP-4 (2% pet) in a screening allergen series. Methods: Retrospective analysis of patients tested to BZP-3 and BZP-4 was conducted by the North American Contact Dermatitis Group from 2013 to 2020. Results: Of 19,618 patients patch tested to BZP-3 and BZP-4, 103 (0.5%) and 323 (1.6%) had positive reactions, respectively: 413 (2.1%) reacted to at least 1 BZP (BZP-positive patient). As compared with BZP-negative patients, BZP-positive patients were significantly more likely to have a history of hay fever (39.3% vs 33.4%, P = 0.0134), history of atopic dermatitis (39.8% vs 30.7%, P = 0.0001), and facial involvement (37.4% vs 32.2%, P = 0.0272). Most reactions were currently clinically relevant (BZP-3: 90.4%; BZP-4: 65.8%). Common identified sources included PCPs and sunscreens. Coreactivity between BZP-3 and BZP-4 was low: 13.5% (14/104) of BZP-3-positive patients were allergic to BZP-4 and 4.3% (14/322) of BZP-4-positive patients were allergic to BZP-3. Conclusions: Eight-year prevalence of BZP positivity was 2.1%. Reactions were frequently clinically relevant and linked to PCPs and sunscreens.
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Affiliation(s)
- Erin M Warshaw
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Xiong
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Vincent A DeLeo
- From the Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
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10
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Warshaw EM, Xiong M, DeKoven JG, Taylor JS, Belsito DV, Reeder MJ, Adler BL, Pratt MD, Atwater AR, Maibach HI, Silverberg JI, Yu J, Botto N, Fowler JF, Houle MC, Mowad CM, Dunnick CA, DeLeo VA. Co-reactivity of glucosides: Retrospective analysis of North American Contact Dermatitis Group Data 2019-2020. Contact Dermatitis 2023; 88:153-156. [PMID: 36268749 DOI: 10.1111/cod.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/02/2022] [Accepted: 10/14/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Michelle Xiong
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brandon L Adler
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - JiaDe Yu
- Department of Dermatology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Nina Botto
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Québec, Laval University, Québec City, Quebec, Canada
| | - Christen M Mowad
- Division of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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11
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Warshaw EM, Xiong M, Atwater AR, DeKoven JG, Pratt MD, Maibach HI, Taylor JS, Belsito DV, Silverberg JI, Reeder MJ, Zug KA, Sasseville D, Fowler JF, DeLeo VA, Houle MC, Dunnick CA. Patch testing with glucosides: The North American Contact Dermatitis Group experience, 2009-2018. J Am Acad Dermatol 2022; 87:1033-1041. [PMID: 35551968 DOI: 10.1016/j.jaad.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Alkyl glucosides are nonionic surfactants that are increasingly used in personal care products. OBJECTIVE To characterize positive patch test reactions to decyl glucoside (5% petrolatum, tested 2009-2018) and lauryl glucoside (3% petrolatum, tested 2017-2018). METHODS Retrospective analysis of patients tested by the North American Contact Dermatitis Group. RESULTS Of 24,097 patients patch tested to decyl and/or lauryl glucoside, 470 (2.0%) had positive reactions. Compared with glucoside-negative patients, glucoside-positive patients had higher odds of occupational skin disease (13.4% vs 10.1%; P = .0207), history of hay fever (38.5% vs 31.6%; P = .0014), atopic dermatitis (39.0% vs 28.6%; P < .0001), and/or asthma (21.8% vs 16.5%; P = .0023). Most glucoside reactions (83.9%) were currently relevant. The most common source was personal care products (63.0%), especially hair products (16.5%) and skin cleansers (15.2%). Of 4933 patients tested to decyl and lauryl glucoside, 134 (2.7%) were positive to 1 or both; 43.4% (43 of 99) of decyl-positive patients were also positive to lauryl glucoside and 55.1% (43/78) of lauryl glucoside patients were also positive to decyl glucoside. LIMITATIONS The cohort predominantly reflects a referral population, and follow-up after testing was not captured. CONCLUSION Glucoside positivity occurred in 2.0% of the tested patients. Reactions were often clinically relevant and linked to personal care products. Cross-reactivity was >40%.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Michelle Xiong
- Department of Dermatology, Park Nicollet/Health Partners Health Services, Minneapolis, Minnesota; Warren Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Québec, Canada
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire Québec, Laval University, Laval, Québec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado
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12
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Kibbie J, Kines K, Norris D, Dunnick CA. Oral tofacitinib for the treatment of alopecia areata in pediatric patients. Pediatr Dermatol 2022; 39:31-34. [PMID: 34779041 DOI: 10.1111/pde.14855] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Alopecia areata (AA) is characterized by the loss of hair, often in well-demarcated areas. While the pathogenesis of AA is not entirely understood, it is known that CD8 T cell-mediated destruction of the hair follicle occurs. There are no curative therapies for AA, although several therapies have been utilized with variable results. Oral tofacitinib, a JAK inhibitor, has been demonstrated to be efficacious and well tolerated in the treatment of adult AA. However, few studies have examined the clinical efficacy and tolerability of oral tofacitinib in the treatment of pediatric AA. OBJECTIVE To summarize the clinical outcomes of pediatric patients with AA treated with oral tofacitinib at the University of Colorado Hospital Dermatology Clinic. METHODS This is a retrospective case series conducted at the University of Colorado Hospital Dermatology Clinic. We included patients with a diagnosis of AA who were 18 years old or younger at the initiation of tofacitinib therapy. Demographics, treatment response, and adverse events were collected from electronic medical records. RESULTS Eleven patients (seven females, four males) with AA presented to the University of Colorado Hospital Dermatology Clinic who were between the ages of 8 and 18 years. Eight patients (72.7%) experienced hair regrowth with oral tofacitinib, while three patients (27.3%) experienced minimal to no hair regrowth. There were no serious adverse events recorded in the study population during the observed treatment period. CONCLUSIONS Oral tofacitinib was clinically effective in the majority our of patients and well tolerated.
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Affiliation(s)
- Jon Kibbie
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelsey Kines
- University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David Norris
- University of Colorado School of Medicine, Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory A Dunnick
- University of Colorado School of Medicine, Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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13
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Hill MK, Laughter MR, Harmange CI, Dellavalle RP, Rundle CW, Dunnick CA. The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment. JMIR Dermatol 2021; 4:e30620. [PMID: 37632827 PMCID: PMC10334971 DOI: 10.2196/30620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/19/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). OBJECTIVE The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. METHODS A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. RESULTS Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. CONCLUSIONS This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis.
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Affiliation(s)
- Mary K Hill
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Cecile I Harmange
- School of Medicine, University of Colorado, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, United States Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Chandler W Rundle
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, United States Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, United States
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14
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Warshaw EM, Buonomo M, DeKoven JG, Pratt MD, Reeder MJ, Silverberg JI, Belsito DV, Maibach HI, Atwater AR, Houle MC, Taylor JS, Zug KA, DeLeo VA, Dunnick CA. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol 2021; 157:1456-1465. [PMID: 34730775 PMCID: PMC8567181 DOI: 10.1001/jamadermatol.2021.4314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/23/2021] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Patch test screening series for patients with dermatitis are limited and may miss clinically relevant contact allergens. OBJECTIVE To characterize individuals with dermatitis who showed clinically relevant patch test findings to supplemental (nonscreening) allergens or substances. DESIGN, SETTING, AND PARTICIPANTS A 17-year, retrospective cross-sectional analysis (January 1, 2001, to December 31, 2018) of North American Contact Dermatitis Group (NACDG) data from multiple centers in North America was conducted. A total of 43 417 patients with dermatitis underwent patch testing to the NACDG screening series in a standardized manner with 65 to 70 allergens and supplemental allergens as clinically indicated. Patients with 1 or more clinically relevant reactions to a supplemental (nonscreening) allergen/substance were analyzed between November 18, 2020, and March 12, 2021. MAIN OUTCOMES AND MEASURES The main outcomes were to assess the number of patients with clinically relevant reactions to supplemental (nonscreening) allergens and compare characteristics (including demographic characteristics and occupations) between patients with a clinically relevant patch test reaction to 1 or more supplemental allergens or substances (supplement-positive) and those without a reaction (supplement-negative) using odds ratios (ORs) and 95% CIs. Secondary outcomes included sources of allergic contact dermatitis and, for occupationally related cases, specific occupations and industries. RESULTS Of 43 417 patients included in the study who underwent patch testing to the NACDG screening series (65-70 allergens), 9507 individuals (21.9%) had currently relevant reactions to 1 or more supplemental allergens or substances. Of these, 6608 were women (69.5%) and the mean (SD) age was 47.2 (0.54) years. Compared with patients who had supplement-negative results, patients with supplement-positive findings were significantly less likely to be male (OR, 0.90; 95% CI, 0.85-0.94; P < .001) and/or have atopic dermatitis (OR, 0.89; 95% CI, 0.84-0.93; P < .001). Common primary sites of dermatitis in 9499 patients with supplement-positive findings included the face (2856 [30.1%]), hands (2029 [21.4%]), and scattered/generalized distribution (1645 [17.3%]). Frequent sources of supplemental allergens in 9235 patients included personal care products (4746 [51.4%]) and clothing/wearing apparel (1674 [18.1%]). Of 9362 patients with available data, supplemental allergens/substances were occupationally related in 1580 (16.9%); of those with identified occupations, 25.1% (384 of 1529) were precision production, craft, or repair workers. Of 9507 patients with supplement-positive findings, 2447 (25.7%) had no currently relevant reactions to NACDG screening allergens. CONCLUSIONS AND RELEVANCE This cross-sectional study found that 21.9% of patients who underwent patch testing to an allergen screening series of 65 to 70 allergens had at least 1 relevant reaction to supplemental allergens/substances. Of these, one-quarter reacted only to a supplemental allergen/substance. Screening series include common, important allergens, but these findings suggest that the addition of specialty allergens and personal or work products is critical for the successful diagnosis and management of allergic contact dermatitis.
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Affiliation(s)
- Erin M. Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota
- Department of Dermatology, University of Minnesota, Minneapolis
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Michele Buonomo
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
- University of Minnesota Medical School, Minneapolis
| | - Joel G. DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Melanie D. Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J. Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Donald V. Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York
| | | | - Amber R. Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - James S. Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn A. Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Vincent A. DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
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15
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Anand P, Szeto MD, Flaten H, D'Angelo J, Dunnick CA, Dellavalle RP. Dermatology residency research policies: A 2021 national survey. Int J Womens Dermatol 2021; 7:787-792. [PMID: 35028383 PMCID: PMC8714577 DOI: 10.1016/j.ijwd.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In this follow-up study to previous work, the authors survey the availability of key measures and resources pertaining to residency research in U.S. Accreditation Council for Graduate Medical Education-accredited dermatology residency programs, including potential policy changes following the COVID-19 pandemic. OBJECTIVE The chief objective of this survey was to evaluate and compare dermatology programs' resident research requirements and guidelines. METHODS This cross-sectional study employed a 13-item survey administered online in early 2021 to assess the degree to which dermatology residency programs require and support their new physician graduates in scholarly research endeavors. RESULTS A total of 32 program directors representing 30 dermatology residency programs (30 of 138 accredited programs contacted [22%]) responded to the survey. Almost all programs described quality improvement project requirements for residents and were able to provide funding for resident conference participation. Most programs also reported resident publication requirements and the availability of research electives. However, the vast majority did not have required research rotations or a formal mentorship program. The COVID-19 pandemic did not have a substantial impact on residency research requirements. CONCLUSION Our survey provides objective data about the current dermatology resident research requirements across the United States. These findings may prove valuable to prospective applicants, residency programs, and accrediting agencies in improving, advancing, and structuring dermatology residency guidelines and resources with the aim of encouraging new physician trainees to pursue research.
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Key Words
- AAD, American Academy of Dermatology
- ACGME, Accreditation Council for Graduate Medical Education
- AMA, American Medical Association
- AOA, Alpha Omega Alpha
- COMIRB, Colorado Multiple Institutional Review Board
- Dermatology
- NIH, National Institutes of Health
- NRMP, National Resident Matching Program
- QI, Quality Improvement
- REDCap, Research Electronic Data Capture
- RRC, Residency Review Committee
- U.S., United States
- USMLE, United States Medical Licensing Examination
- accreditation
- education
- policies
- requirements
- research
- residency
- survey
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Affiliation(s)
- Pratibha Anand
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mindy D. Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Hania Flaten
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Josephine D'Angelo
- State University of New York Upstate Medical University, Syracuse, New York
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Robert P. Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
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16
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Silverberg JI, Hou A, Warshaw EM, Maibach HI, Belsito DV, DeKoven JG, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Atwater AR, Fowler JF, Zirwas MJ, Marks JG, Dunnick CA, Houle MC. Allergens in patients with a diagnosis of seborrheic dermatitis, North American Contact Dermatitis Group data, 2001-2016. J Am Acad Dermatol 2021; 86:460-463. [PMID: 34582838 DOI: 10.1016/j.jaad.2021.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/04/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada
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17
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Warshaw EM, Ruggiero JL, DeKoven JG, Pratt MD, Silverberg JI, Maibach HI, Zug KA, Atwater AR, Taylor JS, Reeder MJ, Sasseville D, Fowler JF, Fransway AF, Belsito DV, DeLeo VA, Houle MC, Dunnick CA. Patch Testing with Ammonium Persulfate: The North American Contact Dermatitis Group Experience, 2015-2018. J Am Acad Dermatol 2021; 87:1014-1023. [PMID: 34390784 DOI: 10.1016/j.jaad.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ammonium persulfate (APS), an oxidizing agent used in hair products, manufacturing, and pool/spa water, can cause skin reactions including allergic contact dermatitis. OBJECTIVE To characterize positive patch test reactions to APS (2.5% pet). METHODS Retrospective analysis of patients tested to the North American Contact Dermatitis Group (NACDG) screening series from 2015-2018. RESULTS Of 10,526 patients, 193 (1.8%) had positive patch test reactions to APS. Compared to negative patients, APS-positive patients were significantly more likely to be male (43.2% vs. 28.0%, p<0.0001), have primary hand (30.2% vs. 22.0%, p=0.0064), scattered generalized (25.5% vs. 17.9%, p=0.0064), or trunk dermatitis (8.9% vs. 4.9%, p=0.0123), and occupationally-related dermatitis (22.2% vs. 10.9%, p<0.0001). Over half of the APS-positive reactions were currently relevant (57.0%); 19 (9.8%) were related to occupation, especially (68.4%) hairdressers. Swimming pools/spas (23.3%) and hair care products (19.2%) were the most common APS sources. LIMITATIONS Immediate reactions and follow-up testing not captured. CONCLUSIONS The proportion of patients positive to APS was 1.8%. APS positivity was significantly associated with male sex and hand dermatitis. Swimming pool/spa chemicals are important sources of APS exposure.
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Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, University of Minnesota, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center
| | - Jenna L Ruggiero
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, MN; Department of Dermatology, Minneapolis Veterans Affairs Medical Center; University of Minnesota Medical School, Minneapolis, MN.
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ontario, Canada
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, NY
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, CA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
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18
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Warshaw EM, Shaver RL, DeKoven JG, Taylor JS, Zug KA, Pratt MD, Atwater AR, Houle MC, Maibach HI, Belsito DV, Silverberg JI, Dunnick CA, Reeder MJ, Sasseville D, Fowler JF, DeLeo VA. Patients with patch test reactions associated with eye care products: Retrospective analysis of North American contact dermatitis group data, 2001-2018. Contact Dermatitis 2021; 85:712-715. [PMID: 34314025 DOI: 10.1111/cod.13950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Rob L Shaver
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Québec, Québec, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
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19
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Silverberg JI, Hou A, Warshaw EM, DeKoven JG, Maibach HI, Belsito DV, Zug KA, Taylor JS, Sasseville D, Dunnick CA, Houle MC, Atwater AR, Reeder MJ, DeLeo VA, Pratt MD, Fowler JF, Zirwas MJ, Marks JG. Age-related differences in patch testing results among children: Analysis of North American Contact Dermatitis Group Data, 2001-2018. J Am Acad Dermatol 2021; 86:818-826. [PMID: 34314743 DOI: 10.1016/j.jaad.2021.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND An updated understanding of allergic contact dermatitis is needed, particularly in children. OBJECTIVES To compare positive and clinically relevant reactions in children versus adults referred for patch testing. METHODS Retrospective analysis of 1871 children and 41,699 adults from the North American Contact Dermatitis Group (NACDG) from 2001-2018. RESULTS Both final diagnosis of allergic contact dermatitis (55.2% versus 57.3%; chi square, P = .0716) and prevalence of ≥ 1 currently relevant reaction to a NACDG screening allergen (49.2% vs 52.2%; P = .1178) were similar between children and adults. Currently in children, the most common relevant allergens were nickel sulfate (17.3%), hydroperoxides of linalool (7.8%), methylisothiazolinone (7.7%), cobalt chloride (7.0%), and fragrance mix I (4.9%). Approximately a fifth of children had a positive reaction to a non-NACDG allergen. CONCLUSION Over half of children referred for patch testing were diagnosed with allergic contact dermatitis. The most common relevant allergens in children were nickel sulfate, cobalt chloride, and hydroperoxides of linalool. Twenty percent of children had at least 1 positive reaction to allergens/substances not on the NACDG screening series, underscoring the need for comprehensive testing.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, DC; Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Aurora, Colorado
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Quebec, Canada
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph F Fowler
- Division of Dermatology University of Louisville, Louisville, Kentucky
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Hershey, Pennsylvania
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20
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Mamo A, Szeto MD, Rietcheck H, Yu S, Burrows K, Olayinka JT, Anand P, Dellavalle RP, Dunnick CA. Evaluating medical student assessment of common dermatologic conditions across Fitzpatrick phototypes and skin of color. J Am Acad Dermatol 2021; 87:167-169. [PMID: 34217806 DOI: 10.1016/j.jaad.2021.06.868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Andrina Mamo
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Hope Rietcheck
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie Yu
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Khyla Burrows
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Pratibha Anand
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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21
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Maghfour J, Rietcheck H, Szeto MD, Rundle CW, Sivesind TE, Dellavalle RP, Lio P, Dunnick CA, Fernandez J, Yardley H. Tolerability profile of topical cannabidiol and palmitoylethanolamide: a compilation of single-centre randomized evaluator-blinded clinical and in vitro studies in normal skin. Clin Exp Dermatol 2021; 46:1518-1529. [PMID: 34022073 DOI: 10.1111/ced.14749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increasing number of studies have investigated the adverse effect profile of oral cannabinoids; however, few studies have provided sufficient data on the tolerability of topical cannabinoids in human participants. AIM To assess the tolerability profile of several commercial topical formulations containing cannabidiol (CBD) and palmitoylethanolamide (PEA) on the skin of healthy human participants. METHODS Three human clinical trials and one in vitro study were conducted. The potential for skin irritation, sensitization and phototoxicity of several products, were assessed via patch testing on healthy human skin. The products assessed included two formulations containing CBD and PEA, one containing hemp seed oil and four concentrations of CBD alone. Ocular toxicity was tested using a traditional hen's egg chorioallantoic membrane model with three CBD, PEA and hemp seed oil formulations. RESULTS There was no irritation or sensitization of the products evident via patch testing on healthy participants. Additionally, mild phototoxicity of a hemp seed oil product was found at the 48-h time point compared with the negative control. The in vitro experiment demonstrated comparable effects of cannabinoid products with historically nonirritating products. CONCLUSION These specific formulations of CBD- and PEA-containing products are nonirritating and nonsensitizing in healthy adults, and further encourage similar research assessing their long-term safety and efficacy in human participants with dermatological diseases. There are some limitations to the study: (i) external validity may be limited as formulations from a single manufacturer were used for this study, while vast heterogeneity exists across unregulated, commercial CBD products on the market; and (ii) products were assessed only on normal, nondiseased human skin, and therefore extrapolation to those with dermatological diseases cannot be assumed.
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Affiliation(s)
- J Maghfour
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - H Rietcheck
- Dermatology, University of Colorado, Aurora, CO, USA
| | - M D Szeto
- Dermatology, University of Colorado, Aurora, CO, USA
| | - C W Rundle
- Dermatology, University of Colorado, Aurora, CO, USA
| | - T E Sivesind
- Dermatology, University of Colorado, Aurora, CO, USA
| | | | - P Lio
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - C A Dunnick
- Dermatology, University of Colorado, Aurora, CO, USA
| | | | - H Yardley
- CQ Science, Denver, CO, USA.,Naturally Curious Consulting, Boulder, CO, USA
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22
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Silverberg JI, Hou A, DeKoven JG, Warshaw EM, Maibach HI, Atwater AR, Belsito DV, Zug KA, Taylor JS, Sasseville D, Fransway AF, DeLeo VA, Pratt MD, Reeder MJ, Fowler JF, Zirwas MJ, Marks JG, Dunnick CA, Houle MC. Prevalence and trend of allergen sensitization in patients referred for patch testing with a final diagnosis of psoriasis: North American Contact Dermatitis Group data, 2001-2016. Contact Dermatitis 2021; 85:435-445. [PMID: 33931870 DOI: 10.1111/cod.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the relationship between psoriasis and allergic contact dermatitis (ACD). OBJECTIVE To examine the associations with ACD, related clinical characteristics, and common positive and clinically relevant allergens of patients with a final diagnosis of psoriasis who were referred for patch testing. METHODS Retrospective analysis of 38 723 patients from the North American Contact Dermatitis Group. RESULTS Patients with a final diagnosis of psoriasis had lower proportions of ACD than those without psoriasis (32.7% vs 57.8%). In multivariable logistic regression models, psoriasis was inversely associated with female sex, Black or Asian race, and history of atopic dermatitis and hay fever. Patients with a final diagnosis of psoriasis were less likely to have one or more positive allergic patch-test reactions or to have a current clinically relevant patch-test reaction to the majority of the most commonly positive and/or relevant allergens. The most clinically relevant allergens included nickel sulfate, methylisothiazolinone, and fragrance mix I. CONCLUSION Approximately one-third of patients who were referred for patch testing with a final diagnosis of psoriasis were also diagnosed with ACD. In select patients with suspected psoriasis who also have a clinical presentation suggestive of ACD, patch testing may be helpful.
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Affiliation(s)
- Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine, Washington, District of Columbia, USA
| | - Alexander Hou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Matthew J Zirwas
- Department of Dermatology, Ohio State University, Columbus, Ohio, USA
| | - James G Marks
- Department of Dermatology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Dermatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Quebec, Laval University, Quebec, Quebec, Canada
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23
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Warshaw EM, Shaver RL, Atwater AR, Maibach HI, Sasseville D, Reeder MJ, DeKoven JG, Taylor JS, Belsito DV, Silverberg JI, Zug KA, Fowler JF, Pratt MD, Fransway AF, DeLeo VA, Houle MC, Dunnick CA. Contact dermatitis in music professionals referred for patch testing: North American Contact Dermatitis Group data, 1996-2018. Contact Dermatitis 2021; 85:359-362. [PMID: 33783009 DOI: 10.1111/cod.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Erin M Warshaw
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Rob L Shaver
- Department of Dermatology, Park Nicollet Health Services, Minneapolis, Minnesota, USA.,Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA.,School of Medicine, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Amber R Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Denis Sasseville
- Division of Dermatology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical School, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joseph F Fowler
- Division of Dermatology, University of Louisville, Louisville, Kentucky, USA
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, Toronto, Ontario, Canada
| | - Anthony F Fransway
- Department of Dermatology, Associates in Dermatology, Fort Myers, Florida, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, Los Angeles, California, USA
| | - Marie-Claude Houle
- Division of Dermatology, CHU de Québec, Laval University, Quebec City, Quebec, Canada
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado, Boulder, Colorado, USA
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24
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Laughter MR, Maymone MBC, Karimkhani C, Rundle C, Hu S, Wolfe S, Abuabara K, Hollingsworth P, Weintraub GS, Dunnick CA, Kisa A, Damiani G, Sheikh A, Singh JA, Fukumoto T, Desai R, Grada A, Filip I, Radfar A, Naghavi M, Dellavalle RP. The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017. JAMA Dermatol 2021; 156:874-881. [PMID: 32520352 DOI: 10.1001/jamadermatol.2020.1573] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making. Objective To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017. Design, Setting, and Participants For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020. Main Outcomes and Measures Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017. Results Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]). Conclusions and Relevance Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.
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Affiliation(s)
- Melissa R Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Chante Karimkhani
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Chandler Rundle
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Sophia Hu
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Sophia Wolfe
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco
| | - Parker Hollingsworth
- Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gil S Weintraub
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver
| | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway.,Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.,Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Jasvinder A Singh
- Medicine Service, Veterans Affairs Medical Center, Birmingham, Alabama.,Department of Medicine at the School of Medicine, University of Alabama at Birmingham, Birmingham.,Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
| | - Takeshi Fukumoto
- Kobe University Graduate School of Medicine, Division of Dermatology, Department of Internal Related, Kobe, Japan.,Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, Pennsylvania
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Ayman Grada
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Amir Radfar
- College of Medicine, University of Central Florida, Orlando
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver
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Fortugno A, Mirhossaini RB, Barbulescu C, Dellavalle RP, Dunnick CA, Sadeghpour M. 13292 Skin of color representation in scientific sessions within the AAD annual meetings. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Flaten H, Dunnick CA, Dellavalle RP, Lehrer M, Schultz A. 18216 Dermatology tactile learning tool: Development and student evaluation of an interactive 3-dimensional skin lesion model for medical student education. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Newman SA, Laughter MR, Williams NK, Peart J, Boyers LN, Capp R, Dunnick CA. The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology. J Am Acad Dermatol 2020; 85:992-994. [PMID: 33010312 DOI: 10.1016/j.jaad.2020.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sabrina A Newman
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado.
| | | | - Nazanin Kalani Williams
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Jenna Peart
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Lindsay N Boyers
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Roberta Capp
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, Colorado; Dermatology Service, US Department of Veteran Affairs, Eastern Colorado Health Care System, Aurora, Colorado
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28
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Rundle CW, Presley CL, Militello M, Barber C, Powell DL, Jacob SE, Atwater AR, Watsky KL, Yu J, Dunnick CA. Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society. J Am Acad Dermatol 2020; 83:1730-1737. [PMID: 32707253 PMCID: PMC7373692 DOI: 10.1016/j.jaad.2020.07.057] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 01/04/2023]
Abstract
The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.
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Affiliation(s)
- Chandler W Rundle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Colby L Presley
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Michelle Militello
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Cara Barber
- Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Douglas L Powell
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Sharon E Jacob
- Loma Linda Veterans Affairs Medical Center, Loma Linda, California; Department Medicine and Pediatrics, University of California, Riverside, California; Department of Dermatology, Loma Linda University Center, Loma Linda, California
| | - Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Kalman L Watsky
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Jiade Yu
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
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29
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Eason CD, Rundle C, Dunnick CA, Hugh J, Dellavalle RP. National trends in free public sunscreen dispensers. J Am Acad Dermatol 2020; 84:1109-1111. [PMID: 32504723 DOI: 10.1016/j.jaad.2020.05.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Chelsea D Eason
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston
| | - Chandler Rundle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
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30
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Maymone MBC, Venkatesh S, Laughter M, Abdat R, Hugh J, Dacso MM, Rao PN, Stryjewska BM, Dunnick CA, Dellavalle RP. Leprosy: Treatment and management of complications. J Am Acad Dermatol 2020; 83:17-30. [PMID: 32244016 DOI: 10.1016/j.jaad.2019.10.138] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/25/2023]
Abstract
In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients' quality of life.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Rana Abdat
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Delhi, India
| | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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31
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Maymone MBC, Laughter M, Venkatesh S, Dacso MM, Rao PN, Stryjewska BM, Hugh J, Dellavalle RP, Dunnick CA. Leprosy: Clinical aspects and diagnostic techniques. J Am Acad Dermatol 2020; 83:1-14. [PMID: 32229279 DOI: 10.1016/j.jaad.2019.12.080] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/26/2019] [Accepted: 12/11/2019] [Indexed: 01/27/2023]
Abstract
Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared "eliminated" as a global public health problem by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.
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Affiliation(s)
- Mayra B C Maymone
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Melissa Laughter
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Samantha Venkatesh
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Mara M Dacso
- National Hansen's (Leprosy) Disease Program, Baton Rouge, Louisiana; University of Texas Southwestern Medical Center, Dallas, Texas
| | - P Narasimha Rao
- Special Interest Group on Leprosy, Indian Association of Dermatologists, Venereologists and Leprologists, Hyderabad, India
| | | | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Denver, Colorado.
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32
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Ford AR, Gibbons CM, Torres J, Kornmehl HA, Singh S, Young PM, Chambers CJ, Maverakis E, Dunnick CA, Armstrong AW. Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial. Telemed J E Health 2019; 25:619-627. [PMID: 30222518 PMCID: PMC6417973 DOI: 10.1089/tmj.2018.0160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background:Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes.Introduction:We performed a 12-month randomized controlled trial to evaluate the impact of an online, collaborative connected health (CCH) model for psoriasis management on access to specialty care.Materials and Methods:The 300 enrolled patients were randomized to online or in-person care. We compared distance traveled as well as transportation and in-office waiting time between the two groups and obtained patient and provider perspectives on CCH.Results:At baseline, no differences existed between the groups in difficulties obtaining specialty care. Over 12 months, the mean (standard deviation [SD]) distance traveled to and from appointments was 174.8 (±577.4) km/person for the in-person group and 2.2 (±14.2) km/person for the online group (p = 0.0003). The mean (SD) time spent on transportation and in-office waiting for in-person appointments was 4.0 (±4.5) h/person for the in-person group and 0.1 (±0.4) h/person for the online group (p = 0.0001). Patients found CCH to be safe, accessible, equitable, efficient, effective, and patient-centered. Providers found CCH to be useful for providing psoriasis care.Discussion:The CCH model resulted in significantly less distance traveled as well as transportation and in-office waiting time compared to in-person care. Both patients and providers were highly satisfied with CCH.Conclusions:The CCH model resulted in increased access to specialty care and enabled patient-centered, safe, and effective management of psoriasis patients.
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Affiliation(s)
- Adam R. Ford
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Caitlin M. Gibbons
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Josefina Torres
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Heather A. Kornmehl
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Sanminder Singh
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Paulina M. Young
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Cindy J. Chambers
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Schoolof Medicine, University of Colorado Denver, Aurora, Colorado
| | - April W. Armstrong
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
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33
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Kuschel SL, Ricotti CM, Dunnick CA, Hugh J, Dellavalle RP. Analysis of conflicts of interest in pharmaceutical payments made to Food and Drug Administration physician advisers after dermatologic drug approval. J Am Acad Dermatol 2019; 81:1419-1420. [PMID: 31150703 DOI: 10.1016/j.jaad.2019.05.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Jeremy Hugh
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Rocky Mountain Regional VA Medical Center, Aurora, Colorado.
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34
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Kalani N, Guidry JA, Farahi JM, Stewart SB, Dellavalle RP, Dunnick CA. Pediatric melanoma: Characterizing 256 cases from the Colorado Central Cancer Registry. Pediatr Dermatol 2019; 36:219-222. [PMID: 30793788 DOI: 10.1111/pde.13747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Melanoma is a rare diagnosis in the pediatric population. Differences in incidence, presentation, and survival distinguish pediatric melanoma from adult melanoma. In order to improve our understanding of pediatric melanoma, our case series investigates differences in incidence, age of onset, and anatomic site between male and female pediatric melanoma patients in Colorado between 1988 and 2015. METHODS All data were gathered from the Colorado Central Cancer Registry. A request for de-identified data on pediatric melanoma patients between 1988 and 2015 was made by the University of Colorado Department of Dermatology. Chi-square tests were used to compare the differences reported in melanoma between sex, age-groups, and site of lesion. RESULTS A total of 256 cases of melanoma were reported in Colorado in patients < 20 years of age between 1988 and 2015. Overall incidence of pediatric melanoma in Colorado increased from 1988 to 1999 but declined from 2001 to 2011. There was a significant predominance of female cases in the 10-14 age-group (P = 0.0477) and 15-19 age-group (P = 0.0472). Both groups had increased incidence of melanoma with increasing age. The mean age of onset for both sexes was 16 years old. Boys were more likely to have melanoma of the scalp and neck (P = 0.0523) and less likely to have melanoma of the leg (P = 0.0049). CONCLUSION Among the pediatric population, girls 10-14 and 15-19 years old are at a significantly increased risk of melanoma compared to boys in these age-groups. Our study found sex-specific differences in anatomic site consistent with prior literature. Further investigations should aim to identify causes for these sex-specific differences in order to better guide public health initiatives.
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Affiliation(s)
- Nazanin Kalani
- University of Colorado School of Medicine, Aurora, Colorado
| | - Jacqueline A Guidry
- Department of Dermatology, University of Colorado Hospital, Aurora, Colorado
| | - Jessica M Farahi
- Department of Dermatology, University of Colorado Hospital, Aurora, Colorado
| | - Stephanie B Stewart
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Hospital, Aurora, Colorado.,Department of Dermatology Denver, Denver Veterans Affairs Medical Center (VAMC), Aurora, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Hospital, Aurora, Colorado.,Department of Dermatology Denver, Denver Veterans Affairs Medical Center (VAMC), Aurora, Colorado
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35
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Flaten HK, Kuschel S, Dellavalle RP, Dunnick CA. Evaluating dermatology curricula in US medical schools. J Am Acad Dermatol 2019; 85:513-514. [PMID: 30633940 DOI: 10.1016/j.jaad.2018.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hania K Flaten
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado.
| | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Eastern Colorado Veterans Administration Health Care System, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado; Dermatology Service, Eastern Colorado Veterans Administration Health Care System, Aurora, Colorado.
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36
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Armstrong AW, Chambers CJ, Maverakis E, Cheng MY, Dunnick CA, Chren MM, Gelfand JM, Wong DJ, Gibbons BM, Gibbons CM, Torres J, Steel AC, Wang EA, Clark CM, Singh S, Kornmehl HA, Wilken R, Florek AG, Ford AR, Ma C, Ehsani-Chimeh N, Boddu S, Fujita M, Young PM, Rivas-Sanchez C, Cornejo BI, Serna LC, Carlson ER, Lane CJ. Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial. JAMA Netw Open 2018; 1:e183062. [PMID: 30646223 PMCID: PMC6324453 DOI: 10.1001/jamanetworkopen.2018.3062] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes. OBJECTIVE To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care. DESIGN, SETTING, AND PARTICIPANTS The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis. INTERVENTIONS Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score. RESULTS Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was -0.27 (95% CI, -0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was -0.05% (95% CI, -1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was -0.11 (95% CI, -0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement. CONCLUSIONS AND RELEVANCE The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358135.
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Affiliation(s)
- April W. Armstrong
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cindy J. Chambers
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Michelle Y. Cheng
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joel M. Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - David J. Wong
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Brittany M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Caitlin M. Gibbons
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Josefina Torres
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Andrea C. Steel
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Elizabeth A. Wang
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Caitlin M. Clark
- University of Hawaii–Manoa John A. Burns School of Medicine, Honolulu
| | - Sanminder Singh
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | | | - Reason Wilken
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Aleksandra G. Florek
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Adam R. Ford
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Chelsea Ma
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Nazanin Ehsani-Chimeh
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Sucharita Boddu
- Department of Dermatology, University of California Davis School of Medicine, Sacramento
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Denver, Anschutz Medical Campus, Aurora
| | - Paulina M. Young
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Cesar Rivas-Sanchez
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Brenda I. Cornejo
- Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Laura C. Serna
- Clinical and Translational Science Institute, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Eric R. Carlson
- Rocky Vista University College of Osteopathic Medicine, Parker, Colorado
| | - Christianne J. Lane
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles
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Updyke KM, Niu W, St Claire C, Schlager E, Knabel M, Leader NF, Sacotte RM, Dunnick CA, Dellavalle RP. Corrigendum: Editorial boards of dermatology journals and their potential financial conflict of interest. Dermatol Online J 2018; 24:13030/qt3tc2583c. [PMID: 30677841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023] Open
Abstract
The original article was published on August 15, 2018 and corrected on September 15, 2018. The revised version of the article removes a co-author, unintentionally retained during the editorial proofing process. This change appears in the revised online PDF copy of this article.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado Dermatology Service, Eastern Colorado Health Care System, Denver, Colorado Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.
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Updyke KM, Niu W, St Claire C, Schlager E, Knabel M, Leader NF, Sacotte RM, Dunnick CA, Dellavalle RP. Editorial boards of dermatology journals and their potential financial conflict of interest. Dermatol Online J 2018; 24:13030/qt198587m9. [PMID: 30677845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Financial relationships between editorial board members of peer-reviewed journals and pharmaceutical and medical device manufacturing companies can potentially lead to biases and loss of objectivity of the medical literature. The purpose of this study was to evaluate the potential financial conflicts of interest that exist among editorial board members of dermatology journals. METHODS Editorial board members for 36 dermatology journals were identified and searched using the Open Payments database on the Center for Medicare and Medicaid Services website. The total amount of general payments made to these physician editors were collected and stratified using a tier system: 1) nothing reported, 2) >$0 and <$10,000, 3) >$10,000 and <$100,000, and 4) >$100,000. RESULTS We identified 551 editors from 36 dermatology journals for use in our analysis. Some form of general payment was made to 87% of these physicians (480 of 551). Four journals had >25% of their editorial staff receiving >$100,000. CONCLUSIONS Financial relationships exist between editorial board members of dermatology journals and pharmaceutical/medical device manufacturing companies, which could lead to financial conflicts of interest. Publications coming from journals with highly paid physician editors have more potential to be biased.
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Affiliation(s)
- Katelyn M Updyke
- University of Central Florida College of Medicine, Orlando, Florida
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Eagleston LRM, Kalani NK, Patel RR, Flaten HK, Dunnick CA, Dellavalle RP. Cannabinoids in dermatology: a scoping review. Dermatol Online J 2018; 24:13030/qt7pn8c0sb. [PMID: 30142706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 06/08/2023] Open
Abstract
The therapeutic applications of cannabis and cannabinoids are an increasingly conspicuous topic as de-criminalization and legalization of these products continues to expand. A limited number of cannabinoid compounds have been approved for a specific set of conditions. However, the current role of cannabinoids for the treatment of dermatologic conditions remains to be defined. We conducted a review of the current literature to determine the applications of cannabinoids for the therapy of various skin diseases. After conducting our analysis, we found that cannabinoid products have the potential to treat a variety of skin conditions, including acne vulgaris, allergic contact dermatitis, asteatotic dermatitis, atopic dermatitis, hidradenitis suppurativa, Kaposi sarcoma, pruritus, psoriasis, skin cancer, and the cutaneous manifestations of systemic sclerosis. However, the majority of available data on these compounds are pre-clinical and there is a corresponding lack of high-quality randomized, controlled trials that evaluate their effects. Cannabinoids have shown some initial promise as therapy for a variety of skin diseases. However, there is a requirement for thorough pre-clinical research and large-scale, randomized, controlled trials before cannabinoids can be considered safe and effective treatments for these conditions.
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Affiliation(s)
| | | | | | | | | | - Robert P Dellavalle
- University of Colorado School of Medicine, Department of Dermatology, Aurora, Colorado Denver Veterans Affairs Medical Center (VAMC), Department of Dermatology, Denver, Colorado.
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Niu W, Updyke KM, Maxim E, Flaten HK, Dunnick CA, Dellavalle RP. Chinese institutional payments for publishing dermatology journal articles. Dermatol Online J 2018; 24:13030/qt8tp4j6b5. [PMID: 30142730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023] Open
Abstract
Cash prizes for academic publication were introduced by the Department of Physics at Nanjing University in the 1990s. Most Chinese universities and research institutions have established cash rewards for first authors of publications. Potential payments ranged from ~$14,000 for an original research article in JAAD to ~$2000 for a case report in JAMA Dermatology. We examined rewards for publication of academic dermatological articles in China by searching for the cash-reward policies of general and dermatology Chinese hospitals. Specific cash-rewards for publication in the top three highest impact dermatological journals were recorded and compared between two dermatological hospitals, four general hospitals, and Chinese national core journals. Rewards were based upon the Science Citation Index (SCI), impact factor (IF) and publication type. Payment policies were compared between dermatological hospital and general hospitals using the t-test. There was no statistically significant difference between the cash reward payments allotted by general versus dermatological hospitals in China (P=0.32). Chinese authors may receive monetary rewards for a publication in a top dermatology journal based upon journal impact factor and publication type. These policies motivate academic publications and provide an alternative means to reward researchers for their scientific achievements than currently practiced in the West.
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Affiliation(s)
- Wei Niu
- University of Central Florida College of Medicine, Orlando Florida
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Fathi R, Sendelweck MA, Dunnick CA, Stevens R. A hyperpigmented rash on face and chest. Int J Dermatol 2018; 57:791-793. [PMID: 29441564 DOI: 10.1111/ijd.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/21/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ramin Fathi
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
| | - Myra A Sendelweck
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
| | - Ryan Stevens
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
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Flaten HK, St Claire C, Schlager E, Dunnick CA, Dellavalle RP. Growth of mobile applications in dermatology - 2017 update. Dermatol Online J 2018; 24:13030/qt3hs7n9z6. [PMID: 29630159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND More than 80% of households in the US have a smartphone. Growth of mobile applications (apps) has grown in parallel with access to smartphones. Mobile health apps are used in medical fields, including dermatology. These apps allow patients to access information regarding dermatology conditions as well as access physicians via teledermatology. PURPOSE To analyze changes in number of dermatology mobile apps since 2014 and discuss benefits and drawbacks of mobile application growth to dermatology. METHODS Apple, Android, and Windows were queried for dermatology-related apps. The apps were categorized by purpose and compared to previously published data to assess growth and change in dermatology apps. RESULTS A total of 526 dermatology mobile apps were found corresponding to an 80.8% growth in dermatology apps since 2014. The market share of teledermatology increased from 11.0% in 2014 to 20.1% in 2017. CONCLUSIONS Dermatology apps continue to grow at a comparable pace to general app growth. Teledermatology apps experienced significant growth from 2014 to 2017. This growth has allowed time-efficient and cost-effective access to dermatologists, especially in rural areas. The growth of dermatology apps targeting patients allows for patient autonomy but also can result in access to inaccurate information regarding dermatology conditions.
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Affiliation(s)
| | | | | | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado Dermatology Service, Eastern Colorado Health Care System, Denver, Colorado Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.
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Flaten HK, St Claire C, Schlager E, Dunnick CA, Dellavalle RP. Growth of mobile applications in dermatology - 2017 update. Dermatol Online J 2018. [DOI: 10.5070/d3242038180] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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44
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Eagleston LRM, Kalani NK, Patel RR, Flaten HK, Dunnick CA, Dellavalle RP. Cannabinoids in dermatology: a scoping review. Dermatol Online J 2018. [DOI: 10.5070/d3246040706] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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45
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Updyke KM, Niu W, St Claire C, Schlager E, Knabel M, Leader NF, Sacotte RM, Dunnick CA, Dellavalle RP. Corrigendum: Editorial boards of dermatology journals and their potential financial conflict of interest. Dermatol Online J 2018. [DOI: 10.5070/d3249041424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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46
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Updyke KM, Niu W, St Claire C, Schlager E, Knabel M, Leader NF, Sacotte RM, Dunnick CA, Dellavalle RP. Editorial boards of dermatology journals and their potential financial conflict of interest. Dermatol Online J 2018. [DOI: 10.5070/d3248041137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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47
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Niu W, Updyke KM, Maxim E, Flaten HK, Dunnick CA, Dellavalle RP. Chinese institutional payments for publishing dermatology journal articles. Dermatol Online J 2018. [DOI: 10.5070/d3245040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Snyder BM, Mounessa JS, Fazzari M, Caravaglio JV, Kretowicz A, Braunberger T, Wells K, Dunnick CA, Dellavalle RP, Alkousakis T. Greater distance to an academic medical center is associated with poorer melanoma prognostic factors: The University of Colorado Experience. Dermatol Online J 2017; 23:13030/qt9qz0p2bz. [PMID: 29447632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Numerous studies report a correlation between distance to diagnostic provider in an academic medical center and poorer prognosis ofdisease. Limited research on this topic exists with respect to melanoma. METHODS This was a retrospective chart review of 1,463 adults (≥18 years) initially diagnosed with melanoma between 2006-2016. Associations between distance traveled and Breslow depth and presence of metastatic disease were assessed via cumulative and binary logistic regression models, adjusting for patient and tumor characteristics. RESULTS Subjects traveling ≥50 miles had 58% greater odds of having an increased Breslow depth than those traveling less than that distance (OR: 1.58; 95% CI: 1.24-2.01; p<0.0001), and had four times the odds of presenting with metastatic disease (OR: 4.04; 95% CI: 3.00-5.46; p<0.0001). DISCUSSION We highlight the correlation between increased distance to our academic medical center with greater Breslow depths and the presence ofmetastatic disease at presentation. CONCLUSION Future studies assessing other factors and regional differences that limit access to diagnosis might help improve screening efforts to prevent poorer prognosis for patients in these areas.
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Affiliation(s)
- Blake M Snyder
- University of Colorado School of Medicine, Denver, Colorado
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49
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Schneider S, Levandowski CB, Manly C, Dellavalle R, Dunnick CA. Wilderness dermatology: mountain exposures. Dermatol Online J 2017; 23:13030/qt0381q1k0. [PMID: 29447629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/08/2017] [Indexed: 06/08/2023] Open
Abstract
Exploring the mountains is a highly rewarding past time; however, certain high-altitude exposures can lead to dermatologic manifestations. In this review article, the authors will describe cold, solar, and severe weather that one may experience when spending time outdoors. Factors such as increased ultraviolet radiation, temperature extremes, and low partial pressure of oxygen, along with human physiologic parameters also contribute to disease severity and presentation. This review article will address the diagnosis, treatment, and prevention of high-altitude dermatology exposures.
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Affiliation(s)
| | | | | | | | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado.
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