Veverka, Kevin K.

When the final patch test reading is barely discernable, it is termed a doubtful, macular erythema , “?+,” or “+/−” reaction (hereby referred to as doubtful reaction ). Information is conflicting about how to interpret doubtful reactions. Many guidelines do not comment on how to approach doubtful reactions; others state that further evaluation can (not should) be performed. In clinical reports, some investigators regard them as positive allergic reactions; some, as positive under certain circumstances; and many, as negative. Indeed, 16 (84%) of 19 recent reports of patch test reactions to standard/baseline series considered doubtful reactions negative for purposes of the report and did not include the number of these reactions. The problem is that these reactions are common and are not infrequently relevant. We recommend that researchers include frequency of doubtful reactions in reports and that doubtful reactions be assessed with the same scrutiny as stronger allergic reactions in the clinical setting.

Background Patch testing to a standard (baseline) series of allergens is the screening tool used to identify culprit allergens in patients with contact dermatitis. The allergens and concentrations used in a standard series are constantly evolving to be most relevant to the patients being patch tested. Objective The aim of this study was to analyze the 2011–2015 patch test results of the Mayo Clinic standard series. Methods We retrospectively reviewed patch test reactions of standard series allergens from 2011 through 2015 and compared these results with the 2011–2012 and 2013–2014 North American Contact Dermatitis Group (NACDG) reports. Conclusions Of 2582 patients included, 1566 (60.7%) had at least 1 positive reaction, and 516 (20.0%) had at least 1 irritant reaction. The 15 allergens with the highest reaction rates (from highest to lowest) were nickel sulfate hexahydrate, methylisothiazolinone, Myroxylon pereirae resin, neomycin sulfate, cobalt (II) chloride hexahydrate, benzalkonium chloride, fragrance mix I, potassium dichromate, bacitracin, methylchloroisothiazolinone/methylisothiazolinone, carba mix, formaldehyde, p -phenylenediamine, quaternium-15, and methyldibromo glutaronitrile. Twelve (80%) of these allergens were also in the top 15 of the most recent NACDG report; the 3 allergens not in the NACDG top 15 allergens were potassium dichromate, benzalkonium chloride, and methyldibromo glutaronitrile (the latter 2 allergens are not included in their series).

BACKGROUND In-transit cutaneous metastases occur in 5% to 10% of patients with melanoma. Recently, topical diphenylcyclopropenone (DPCP) has been described as a treatment option. OBJECTIVE To evaluate efficacy of DPCP in treatment of in-transit cutaneous melanoma. METHODS The authors retrospectively reviewed the records of 13 consecutive patients with in-transit metastases treated with topical DPCP between March 1, 2013, and January 31, 2017. The authors recorded the response of in-transit cutaneous melanoma lesions treated with DPCP measured by clinical examination. RESULTS Among the 13 patients, 9 patients completed at least a 1-month course of DPCP treatment. Of these 9 patients, 6 (66.7%) maintained either stable disease or had a partial or complete regression, and 3 (33.3%) had progressive disease. Patients with less burden of disease (e.g., <15 lesions) responded more favorably than those with a greater burden of disease (e.g., >25 lesions or plaques). Both patients who received DPCP alone had progression of their cutaneous lesions. One patient who did not become sensitized to DPCP died within 2 months, and his anergy likely reflecting immense burden of disease. CONCLUSION Topical DPCP is a low-cost, patient-applied treatment option for in-transit melanoma, most effective for patients with relatively low tumor burden and localized disease.

Purpose: To describe ophthalmic manifestations of systemic amyloidosis, a group of devastating conditions. Methods: A retrospective chart review including patients who had ocular examinations at Mayo Clinic between January 1, 1985, and April 1, 2014, and a diagnosis of light-chain (AL), secondary (AA), or nontransthyretin familial amyloidosis was undertaken. Sixty-eight patients with AL amyloidosis, eight patients with AA amyloidosis, and five patients with nontransthyretin familial amyloidosis were included. Results: Of 68 patients, 8 patients (14 eyes) with AL amyloidosis had ocular involvement secondary to conjunctiva, temporal artery, extraocular muscle, trabecular meshwork, and cranial nerve deposition. One of the five patients with nontransthyretin familial amyloidosis had gelsolin-related corneal dystrophy. No patients with AA amyloidosis (n = 8) had ophthalmic manifestations. Conclusion: Systemic amyloidosis can lead to ocular morbidity. Patients with AL amyloidosis had involvement of the temporal artery, conjunctiva, extraocular muscles, trabecular meshwork, and cranial nerves. Those with gelsolin nontransthyretin familial amyloidosis were susceptible to corneal dystrophy. Patients with AA amyloidosis did not manifest ophthalmic involvement. Finally, if ocular amyloidosis is detected, patients should be referred for systemic workup.