Clinical Pearls on Sleep Management in Atopic Dermatitis Multiple etiologies contribute to sleep disturbance in atopic dermatitis (AD) patients, including learned scratching behavior and increased monoamines, cutaneous blood flow, inflammatory cell activities, and cytokines, as well as decreased melatonin, anti-inflammatory cytokines, and skin barrier function. Insomnia impairs cognitive development in children with AD, leading to behavioral problems and learning disabilities. Insomnia in adults with AD impedes work productivity. In this article, we discuss pearls on improving insomnia through both nonpharmacologic modalities, such as environmental adjustments and massage therapy, and pharmaceutical approaches including melatonin, antihistamines, tricyclic antidepressants, mirtazapine, and benzodiazepine and nonbenzodiazepine sedatives. Future investigations should further delineate the mechanistic link between insomnia and AD exacerbation and identify strategies to combat sleep-related disease burden.

Real-World Outpatient Prescription Patterns for Atopic Dermatitis in the United States Atopic dermatitis (AD) often requires combination treatment regimens. However, little is known about treatment combinations and polypharmacy in AD. We sought to characterize patterns of outpatient prescriptions and polypharmacy among US children and adults with AD. Data from the 1993–2015 National Ambulatory Medical Care Survey were analyzed, including 128,300 pediatric and 623,935 adult outpatient visits. Among AD visits, dermatologists prescribed more topical corticosteroids (TCSs, P = 0.01) than any other clinicians, particularly multiple TCSs (P < 0.0001), topical calcineurin inhibitors (TCI, P = 0.009), combination TCIs with TCSs (P = 0.004), and systemic immunosuppressants (P = 0.003). Prescriptions for multiple TCSs increased from ages 0 to 19 years, 20 to 39 years, and peaked at 40 to 59 years (P = 0.0002). Prescriptions for prednisone peaked at ages of 40 to 59 years (P = 0.003). A subset of AD patients was prescribed oral antibiotics (7.1%), although fewer than half had a diagnosis of bacterial infection (42.1%). The proportion of patients receiving multiple prescriptions was higher in visits to primary care practitioners versus dermatologists, those with private versus public insurance, and 50 years or older versus 20 to 49 years versus 0 to 19 years. Visits with 4 or more prescriptions by dermatologists increased between 1993–2000 (10%) and 2011–2015 (29%, P = 0.0001). In conclusion, significant treatment variation exists among specialists managing AD, with increasing polypharmacy over time.

Validating a Quality-of-Life Instrument for Allergic Contact Dermatitis Background Contact dermatitis is a prevalent condition that has a significant impact on quality of life (QoL). Although many generic dermatological QoL instruments exist, none were developed by and for patients with allergic contact dermatitis (ACD). Objective The aim of the study was to create and validate a reliable QoL instrument specific for the ACD population. Methods We identified QoL items specific to ACD through a series of qualitative interviews with ACD patients and experts. We created a 17-question survey that queries the patient across the following 3 major domains: symptoms, functioning, and emotions. We used statistical methods to evaluate the reliability and validity of this tool. Results Ninety patients with relevant positive results on patch testing completed the novel ACD instrument and the Skindex-29. This instrument exhibited reliability and validity in individuals with ACD and was more sensitive than the generic tool Skindex-29. Conclusions This novel instrument is the first tool developed specifically to assess the unique impacts of ACD on QoL. Providers can reliably use this index to assess the specific aspects of the disease most problematic for the ACD patient and use this information to more properly inform counseling and management.

Occupationally Related Nickel Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 1998–2016 Background The epidemiology of nickel allergy in occupational settings is not well understood. Objective The aim of the study was to characterize occupationally related nickel allergy (ORNA). Methods This is a retrospective cross-sectional analysis of 44,378 patients patch tested by the North American Contact Dermatitis Group from 1998 to 2016. Characteristics of individuals with ORNA were compared with those with non-ORNA (NORNA). Results A total of 7928 (18.2%) individuals were positive to nickel sulfate 2.5%. Two hundred sixty-eight (3.4%) had ORNA. As compared with NORNA, ORNA was statistically associated with the male sex (41.0% vs 12.9%, P < 0.001), a diagnosis of irritant contact dermatitis (22.4% vs 12.0%, P < 0.001), and no history of eczema (81.7% vs 75.7%, P = 0.0217). The most common sites of ORNA dermatitis were hand (39.9%) and arm (18.1%), which were significantly more common than in NORNA (P < 0.0001). Sixteen industry categories and 22 occupation categories were identified for ORNA; the most common industries were durable goods manufacturing (24.6%) and personal services (15.7%), and the most frequent occupations were hairdressers/cosmetologists/barbers (14.3%), machine operators (9.3%), and health care workers (7.1%). Overall 30% of ORNA occupations were in metalworking. Of 215 ORNA sources identified, instruments/phones/other equipment (16.3%), vehicles/machinery (15.8%), and tools (15.3%) were the most common. Conclusions Occupational nickel allergy is distinct from nonoccupational nickel allergy.

Patch Testing Ingredients of Dermabond and Other Cyanoacrylate-Containing Adhesives Background Cyanoacrylates are strong adhesives used for a variety of medical, industrial, and cosmetic applications and have been implicated as a cause of allergic contact dermatitis. Objective The aim of the study was to review our experience in patch testing with cyanoacrylates. Methods We reviewed patch test results of 38 patients with a clinical history of contact dermatitis due to a cyanoacrylate-containing adhesive (mostly Dermabond). Testing used cyanoacrylates of >99% purity diluted to 10% to 30% in petrolatum (pet.), undiluted octyl cyanoacrylate, and/or Dermabond Mini or Advanced “as is.” Patch tests were also performed with methacrylates, formaldehyde (a cyanoacrylate impurity), benzalkonium chloride, and cyanoacrylate polymerization inhibitors. Three patients were also tested with Dermabond Mini on abraded skin. Results Commercial cyanoacrylate patch testing material (ethyl cyanoacrylate 10% pet.) detected 29% of Dermabond-allergic patients, whereas patch testing with octyl cyanoacrylate 10% pet. increased detection to 50%. Testing with higher concentrations and/or on abraded skin further increased yield. Thirteen (37%) of our 35 cyanoacrylate-allergic patients were also allergic to methacrylates or acrylates. Conclusions Octyl cyanoacrylate is the usual allergenic ingredient in Dermabond. Patch testing with high concentrations is often required. Testing Dermabond on abraded skin further improves diagnostic sensitivity by more closely simulating clinical use.

Allergic Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone Masquerading as Pinworm Infection No abstract available

Representation of Women Among Authors in Dermatitis and Presenters at American Contact Dermatitis Society Annual Meetings: A Look Over 24 Years No abstract available

Pioneers in Dermatology: The American Contact Dermatitis Society Fall 2018 Meeting No abstract available