Davis, Mark D.P.

Abstract: Background: Fragrances/botanicals are ubiquitous allergens. Patients allergic to one fragrance/botanical are frequently sensitive to other fragrances/botanicals and are typically counseled to avoid all fragrances/botanicals. However, broad avoidance of all fragrances/botanicals may not be clinically necessary. Objectives: We examined copositivity patterns in fragrance/botanical patch testing. Methods: The Mayo Clinic patch test database was queried for pairwise copositivity rates for fragrances/botanicals between 1997 and 2022, representing a total of 43 allergens. Data analyzed included 4706 positive reactions out of 252,485 total patches applied to 15,864 patients. After background correction for general positivity, copositivity rates were organized through unsupervised hierarchical clustering to determine copositivity subgroups and then evaluated through network analysis. Results: After background correction, clustering revealed distinct copositivity subgroups: Fragrance Mix I– Myroxylon pereirae –limonene hydroperoxides–linalool hydroperoxides; Compositae Mix–sesquiterpene lactone–parthenolide; Fragrance Mix II–Lyral; lichen acid mix–treemoss extract; menthol– Mentha piperita ; narcissus–dandelion; and Santalum album –trans-anethole–tea tree–lemongrass–clove–turpentine– Rosa damascena – Lavandula – Geranium – Cananga odorata –neroli–bergamot. In addition, there were further isolated intergroup copositivity reactions seen in network analysis. Conclusions: Background correction followed by hierarchical clustering demonstrated the fragrance/botanical group can be divided into multiple copositivity subgroups. Combined with network analysis, patients with a positive patch test to one fragrance/botanical allergen may be preferentially guided to use specific other fragrances/botanicals.

Background: Observations highlighting the “unmasking” of cutaneous T-cell lymphoma after treatment with dupilumab for atopic dermatitis (AD) have been recently reported. However, there remains a paucity of literature describing the evolution of clinical and histopathological features that characterizes this phenomenon. Objective: To define the clinical and histopathologic evolution of atypical lymphoid infiltrates after the administration of dupilumab for AD. Methods: A cross-sectional study of clinical and histopathologic features in 7 consecutive patients with a diagnosis of “atypical lymphoid infiltrate” or mycosis fungoides (MF) on dupilumab for AD was performed. Results: Seven patients with atypical lymphoid infiltrates or MF in evolution after dupilumab therapy (age range 27–74 years) were reviewed. Average duration of AD before MF diagnosis was 5.7 years, and the average duration on dupilumab treatment was 9.8 months. Notable histopathologic features across predupilumab and postdupilumab biopsies included progressive increase in the densities of the atypical lymphoid infiltrates (7/7), presence of atypical epidermotropic lymphocytes (6/7), and papillary dermal fibrosis (6/7). Limitations: Small retrospective cohort study. Conclusion: These cases highlight the transformation of lymphoid infiltrates after dupilumab treatment for AD and emphasize the importance of clinical and histopathologic evaluation before and during treatment with dupilumab for treatment-refractory presumed AD.

AbstractThroughout much of the African continent, healthcare systems are already strained in their efforts to meet the needs of a growing population using limited resources. Climate change threatens to undermine many of the public health gains that have been made in this region in the last several decades via multiple mechanisms, including malnutrition secondary to drought‐induced food insecurity, mass human displacement from newly uninhabitable areas, exacerbation of environmentally sensitive chronic diseases, and enhanced viability of pathogenic microbes and their vectors. We reviewed the literature describing the various direct and indirect effects of climate change on diseases with cutaneous manifestations in Africa. We included non‐communicable diseases such as malignancies (non‐melanoma skin cancers), inflammatory dermatoses (i.e. photosensitive dermatoses, atopic dermatitis), and trauma (skin injury), as well as communicable diseases and neglected tropical diseases. Physicians should be aware of the ways in which climate change threatens human health in low‐ and middle‐income countries in general, and particularly in countries throughout Africa, the world's lowest‐income and second most populous continent.

BackgroundGraft‐versus‐host disease (GVHD) following solid organ transplantation (SOT) is extremely rare and infrequently described in the dermatologic literature.MethodsWe performed a retrospective clinicopathologic review of our institution's experience with patients diagnosed with SOT‐associated GVHD (SOT GVHD) (May 1, 1996 to September 1, 2017).ResultsOf nine patients with SOT GVHD, seven had undergone liver transplantation, while two had undergone lung transplantation. All presented initially with a skin eruption, which developed an average of 63 days (range: 11‐162 days) post transplant. The average time to diagnosis following the onset of the skin eruption was 12 days (range: 0‐54 days). Diagnosis was often delayed because of a competing diagnosis of drug reaction. Frequent skin findings included pruritic erythematous to violaceous macules and papules with desquamation. Histopathology showed vacuolar interface dermatitis in 12 of 15 cases (80.0%). Of the 11 specimens in which a hair follicle was present for evaluation, vacuolar interface changes around the hair follicle were present in eight (72.7%) cases. Seven patients (77.8%) died from complications during the follow‐up period.ConclusionsSOT GVHD presents initially with skin involvement, is associated with vacuolar interface changes on skin biopsy, and is associated with a high mortality rate. Clinicopathologic correlation is required for accurate diagnosis.

AbstractClimate change contributes to the increase in severity and frequency of flooding, which is the most frequent and deadly disaster worldwide. Flood‐related damage can be very severe and include health effects. Among those health impacts, dermatological diseases are one of the most frequently encountered. Both infectious and noninfectious dermatological conditions are increasing after flooding. We searched PubMed using the search term climate change OR global warming OR rainfall OR flooding OR skin. Articles published in the English‐language literature were included. We also searched the International Society of Dermatology website library on climate change for additional articles. There is an increased risk of trauma during the course of a natural disaster. The majority of post‐tsunami wound infections were polymicrobial, but gram‐negative bacteria were the leading causes. Infectious diseases with dermatological manifestations, such as impetigo, leptospirosis, measles, dengue fever, tinea corporis, malaria, and leishmaniasis, are important causes of morbidity among flood‐afflicted individuals. Insect bites and stings, and parasite infestations such as scabies and cutaneous larva migrans are also frequently observed. Inflammatory conditions including irritant contact dermatitis are among the leading dermatological conditions. Dermatological conditions such as alopecia areata, vitiligo, psoriasis, and urticaria can be induced or exacerbated by psychological conditions post disaster. Prevention is essential in the management of skin diseases because of flooding. Avoiding exposure to contaminated environments, wearing protective devices, rapid provision of clean water and sanitation facilities, prompt vector controls, and education about disease risk and prevention are important.

AbstractClimate change refers to variation in the climate of a specific region or globally over time. A change has been reported in the epidemiology of tick‐ and mosquito‐borne diseases in recent decades. Investigators have postulated that this effect may be associated with climate change. We reviewed the English‐language literature describing changes in the epidemiology of specific tick‐ and mosquito‐borne diseases, including the tick‐borne diseases of Lyme disease, tularemia, Crimean‐Congo hemorrhagic fever, Mediterranean spotted fever, and Rocky Mountain spotted fever and the mosquito‐borne diseases of dengue, malaria, West Nile virus infection, Ross River virus disease, and Barmah Forest virus disease. We postulate that the changing epidemiology of tick‐ and mosquito‐borne diseases is related to climate change.

BACKGROUND Hidradenitis suppurativa (HS) is a progressive, recurrent inflammatory disorder. OBJECTIVE To assess long-term satisfaction and postoperative perceptions among patients who underwent surgical management of HS. MATERIALS AND METHODS A questionnaire was mailed to 499 HS surgical patients to assess surgical outcome, satisfaction, and quality of life. RESULTS Of the 499 questionnaires mailed, 113 were returned (22.6% response rate) and 2 were excluded for redundancy. Of the 111 respondents, 65 (58.6%) were female, 91 (82.0%) had Hurley Stage III disease, 88 (79.3%) were treated with excision and 23 (20.7%) with unroofing, 45 (40.5%) had perianal or perineal disease, and 41 (36.9%) had axillary disease. Most patients were satisfied or very satisfied with their surgical results (84.7%; 94 of 111), were glad they underwent surgery (96.3%; 105 of 109), and would recommend surgery to a friend or relative (82.6%; 90 of 109). Most patients were satisfied or very satisfied with the appearance of their healed wound (62.4%; 68 of 109). Retrospective mean quality of life increased significantly from 5 preoperatively to 8.4 postoperatively (p < .001). CONCLUSION Hidradenitis suppurativa surgical management was well regarded by patients and should be considered by future patients to limit the morbidity of HS.