PubMed Health⌕ Search

Biomedical subjects

Donald V Belsito

Publications and source records attributed to Donald V Belsito.

At least 19 recordsLinked to original sources
PubMed2006

The impact of various patient factors on contact allergy to nickel, cobalt, and chromate.

BACKGROUND: Positive patch-test results to nickel, cobalt, and chromate alone and in combinations with one another are well known to occur. Patient factors that may play a role in isolated and concurrent sensitization to these allergens have not been studied in the US population. OBJECTIVE: We sought to determine the prevalence of isolated and concurrent nickel, cobalt, and chromate sensitizations and to investigate the impact of various patient factors on their development. METHODS: A retrospective analysis was carried out on patch-test data of 1187 patients evaluated at one US center from January 1, 1995, to December 31, 2004, 208 of whom had a positive reaction to at least one metal. Statistical analyses to evaluate associations of metal contact allergy with patient factors were performed using the chi(2) test and conditional odds ratio. RESULTS: All patients who reacted to metal had increased odds of cosensitization to another metal. Patients who reacted to nickel were more likely to be female. Those who reacted to chromate were more likely to be male and to have an occupational cause for their dermatitis. There was a strong trend for patients who reacted to cobalt to be non-Caucasian. All those who reacted to metal had increased odds of a history of atopic eczema. Chromate reactions and isolated cobalt reactions were less likely to have known relevance than other (nonmetal) allergens. Several metal allergy combinations showed a predilection toward specific dermatitis sites, especially the scalp, eyelids, ears, and lips. LIMITATIONS: The study was a retrospective analysis, exploratory in nature, and had relatively small numbers of patients with particular multiple metal allergy combinations. CONCLUSION: This research confirms the sex predilections toward nickel and chromate allergy and suggests enhanced sensitivity to metals among those with atopic eczema. The results also serve to raise questions regarding occupationally related chromate allergy in men, the relevance of cobalt allergy, exposure patterns resulting in enhanced sensitivity to cobalt in non-Caucasians, and associations between metal allergens and dermatitis site. The answers to these questions require more detailed studies.

Adult↗
PubMed2006

The aetiology of eyelid dermatitis: a 10-year retrospective analysis.

Few studies have examined the aetiology of eyelid dermatitis across broad demographics. The objectives of this study were (i) to compare the diagnoses of patients with isolated eyelid dermatitis to the diagnoses of patients with additional sites of involvement and (ii) to determine the relevant allergens among patients with allergic eyelid dermatitis. A retrospective analysis of 1215 patients patch tested over 10 years was conducted in this study. Compared to patients without eyelid dermatitis, patients with this entity were more often female. Of the 105 patients with eyelid dermatitis, 43.8% had allergic contact dermatitis (ACD), 36.2% seborrhoeic dermatitis, 11.4% other dermatitis/dermatoses, 7.6% irritant contact dermatitis, 3.8% psoriasis, and 2.9% atopic eczema. With isolated eyelid dermatitis, seborrhoeic dermatitis was the most frequent diagnosis (46.3%) followed by ACD (35.2%). Allergens commonly causing allergic eyelid dermatitis consisted of fragrances, metals, neomycin, oleamidopropyl dimethylamine, tosylamide formaldehyde resin, benzalkonium chloride, and other preservatives. When evaluated according to sites of involvement, seborrhoeic dermatitis was diagnosed most often in patients with isolated eyelid dermatitis, but when dermatitis was distributed to facial or other sites, ACD was the most frequent diagnosis. A majority of the causative allergens for eyelid dermatitis are not present on the Food and Drug Administration-approved panels available in the USA.

Adolescent↗
PubMed2006

Delayed-type hypersensitivity to fragrance materials in a select North American population.

BACKGROUND: In published reports from Europe, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral) has been described as a common cause of allergic contact dermatitis (ACD). In Europe, the rates of reaction to HMPCC among patients undergoing patch testing for suspected ACD have varied from 1.2 to 17.0%, depending on the country. Data on the incidence of sensitivity to HMPCC among North Americans with suspected ACD have not been reported. OBJECTIVES: The goals of this study were (1) to assess the incidence of delayed-type hypersensitivity reactions to HMPCC among patients undergoing patch testing for evaluation of eczematous dermatitis at six centers throughout North America; (2) to determine the most appropriate concentration of HMPCC to use in performing patch tests; and (3) to compare and contrast the incidence rates for HMPCC hypersensitivity to those for other fragrance materials screened with the North American Contact Dermatitis Group (NACDG) screening tray, which includes fragrance mix, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, ylang ylang oil, jasmine absolute, and tea tree oil. METHODS: This report represents the prospective multicenter data on patients tested with the fragrance-related allergens on the NACDG standard screening tray and with HMPCC at 5%, 1.5%, and 0.5% concentrations in petrolatum. Statistical analyses were performed with Student's t-test (two tailed) and the chi-square test. RESULTS: Data from 1,603 patients evaluated at five US sites and one Canadian site were analyzed. Most patients (87.8%) were Caucasian. The majority (67%) were women, and 26.2% had a history consistent with atopic dermatitis. The patients ranged in age from 1 to 88 years, and the mean +/- standard deviation was 46.3 +/- 16.5 years. Myroxilon pereirae (balsam of Peru) and fragrance mix were the most frequent patch-test-positive fragrance allergens (6.6% and 5.9%, respectively). Cinnamic aldehyde (1.7%), ylang ylang oil (0.6%), jasmine absolute (0.4%), HMPCC (0.4% for 5% HMPCC, 0.3% for 1.5% HMPCC, and 0.2% for 0.5% HMPCC), and tea tree oil (0.3%) less frequently yielded positive reactions. Men were more likely than women to be allergic to cinnamic aldehyde. Women were more likely than men to be allergic to jasmine absolute. Atopic patients were no more likely to react to fragrance materials than were nonatopic patients. Patients who reacted to jasmine absolute tended to be older than the general population whereas those who reacted to tea tree oil tended to be younger than the general population. There were no other demographic differences between patients who reacted to a given fragrance material and the entire population studied. Testing with fragrance mix and balsam of Peru failed to identify the majority of patients in this study who were found to be sensitized to jasmine absolute, HMPCC, or tea tree oil. CONCLUSION: HMPCC is an uncommon allergen in the North American population. We recommend testing with 5% HMPCC in petrolatum for those patients suspected of having a fragrance allergy.

Adolescent↗
PubMed2006

Alefacept in the treatment of recalcitrant palmoplantar and erythrodermic psoriasis.

Alefacept is the first biologic agent approved by the US Food and Drug Administration for moderate to severe chronic plaque psoriasis. Prior clinical studies excluded patients with palmoplantar psoriasis or erythroderma. We report 2 patients with recalcitrant psoriasis who responded completely to a full course of alefacept. One patient presented with severe palmoplantar psoriasis recalcitrant to acitretin and methotrexate; another patient presented with erythroderma and was transitioned successfully from cyclosporine A. Alefacept provides another treatment option for palmoplantar and erythrodermic psoriasis and should be considered in the management of patients with these conditions.

Adult↗
PubMed2005

Safety of ingredients used in cosmetics.

The Cosmetic Ingredient Review (CIR) program was established in 1976 by the Cosmetics, Toiletry, and Fragrance Association, with the support of the Food and Drug Administration (FDA) and the Consumer Federation of America (CFA). CIR performs independent, expert reviews to determine if ingredients used in cosmetics are safe. CIR staff prepares summaries of available data and the CIR Expert Panel reviews the data in open, public meetings. If more data are needed, requests are made. Unpublished studies may be provided, but become public and available for review once summarized in CIR safety assessments. Tentative conclusions are supported with a rationale and public comment is sought. Taking any input into consideration, a final safety assessment monograph is issued. These monographs are submitted for publication in the peer-reviewed International Journal of Toxicology . To date, 1194 individual cosmetic ingredients have been addressed. Of these, 683 were found to be safe in cosmetics in the present practices of use and concentration. With qualifications, another 388 have been found safe for use in cosmetics; specific qualifications for each are given. Nine ingredients have been deemed unsafe for use in cosmetics and the safety issue has been described. The available data were found insufficient to support the safety of 114 ingredients; the needed data are listed. Hair dyes represent an important product category reviewed by CIR. In considering hair dyes, the CIR Expert Panel reviews experimental and clinical data specific to the particular chemical structure of each hair dye and reviews epidemiologic studies that address hair dye use that are less specific. Recently the CIR Expert Panel concluded that the available epidemiologic studies are insufficient to conclude there is a causal relationship between hair dye use and cancer and other end points. It is inevitable that new information will become available concerning ingredients for which safety assessments were completed in the early days of the program. To consider new data, the CIR Expert Panel has instituted a re-review program. Sodium lauryl sulfate (SLS), formaldehyde, and parabens are discussed as examples. Safety assessments currently underway are listed, along with high-priority ingredients from which new work will be chosen. Although supported by the cosmetics industry, the CIR program has remained independent in its decision making, based on its open, public process; the integrity of the expert panel members; the participation of the FDA and the CFA; and the cooperation of the cosmetics industry.

Beauty Culture↗
PubMed2005

Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability.

Cutaneous irritant and allergic responses account for the vast majority of cases of occupational contact dermatitis (OCD). Although the pathophysiologic responses to these two different exposures are distinct, the clinical differentiation between chronic cumulative irritant contact dermatitis and allergic contact dermatitis can be difficult and frequently requires patch testing. This article reviews the recommended algorithms that clinicians should utilize to assess whether a worker suffers from OCD. The prevalence of OCD, its predisposing factors (both endogenous and exogenous), and prognosis are discussed in depth. Finally, issues surrounding the assessment of impairment and disability resulting from OCD are summarized.

Age Factors↗
PubMed2004

Patch testing with a standard allergen ("screening") tray: rewards and risks.

The TRUE Test panels, which are the only patch testing devices approved by the Food and Drug Administration in the US, consist of 24 patches, one of which is a negative control. The remaining 23 patches contain 42 unique allergens and four complex mixtures. Although these panels contain approximately 1.4% of the > 3700 known allergens, they perform robustly in detecting allergic contact dermatitis (ACD). Twenty-eight percent of patients are fully evaluated by application of TRUE Test((R)). The present paper reviews the appropriate use of the TRUE Test panels. The need to determine relevance of any positive reaction is stressed. The common causes of false-positive and false-negative reactions are outlined. Those product types where the TRUE Test panels detect the majority of relevant allergic reactions are reviewed, as are the other sources of exposure to the allergens on these panels. The impact of ACD on quality of life is significant. Only by patch testing can the diagnosis be made.

Allergens↗
PubMed2004

Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation.

BACKGROUND: Little has been published regarding the impact of gender, ethnicity, age, and occupation on the quality of life (QoL) of patients with allergic contact dermatitis (ACD). OBJECTIVES: This study investigated the relationship between QoL scores for patients with ACD and variables such as gender, ethnicity, age, and occupation. METHODS: Four hundred twenty-eight patients with ACD were mailed a QoL questionnaire modified from Skindex-16 to include an additional five items pertaining to occupational impact. The QoL scores were analyzed to ascertain factors that affect QoL in patients with ACD. RESULTS: The response rate was 35%. Non-Caucasians reported lower QoL scores than did Caucasians within the functioning scale. There were no statistically significant gender-related differences in QoL scores although females reported a higher degree of emotional distress. Younger subjects were more likely to have lower QoL scores within the functioning and occupational scales. Industrial workers reported the worst occupational QoL, followed by office workers. Occupation was the variable that significantly affected the greatest number of survey subjects, followed by age, ethnicity, and gender. CONCLUSIONS: Three of the four variables examined had a significant association with QoL. Non-Caucasians, younger subjects, and industrial workers reported a significantly worse QoL due to ACD. There were no statistically significant gender-related differences in QoL scores.

Activities of Daily Living↗
PubMed2004

Allergy to cocamidopropyl betaine and amidoamine in North America.

BACKGROUND: The prevalence of allergy to cocamidopropyl betaine (CAPB) in North America has not been previously reported. OBJECTIVE: The aim of this study was to report on the most recent data on allergy to CAPB and a related allergen, amidoamine (AA). METHODS: Data was collected by the North American Contact Dermatitis Group from consecutive patients presenting for patch testing for diagnosis of presumed allergic contact dermatitis (ACD) from January 1, 2001, through December 31, 2001. RESULTS: Of 975 patients tested, 15 were patch-test positive to CAPB, 25 had positive reactions to AA, and 18 had positive reactions to both CAPB and AA. The most frequent site of dermatitis from CAPB was the head and neck region. CONCLUSION: In North America, both CAPB and AA are useful allergens for detecting ACD.

Allergens↗
PubMed2004

Pimecrolimus cream 1%: a potential new treatment for chronic hand dermatitis.

A multicenter, randomized, vehicle-controlled, 3-week study was conducted in patients with chronic hand dermatitis (HD) of various etiologies and locations to identify subgroups particularly responsive to twice-daily application of pimecrolimus cream 1% with overnight occlusion. A total of 294 patients were randomized to the study. By the final visit on day 22, there was a trend toward greater clearance in patients who received pimecrolimus than in those treated with vehicle cream. An analysis of treatment success by various stratification factors was performed, and it was found that palmar involvement had notable impact on response (P = .033). Patients in the pimecrolimus group continued to improve throughout the study; however, in the vehicle group, improvement plateaued after 15 days. Pimecrolimus was well tolerated, with a low rate of application-site reactions such as burning. Pimecrolimus cream 1%, when used twice daily with overnight occlusion, may be of benefit in the management of chronic HD.

Administration, Topical↗
PubMed2004

A diagnostic pearl: the school chair sign.

Allergic contact dermatitis (ACD) reactions to nickel have pleomorphic presentations owing to the ubiquity of this allergen in the environment. In children, ACD to nickel classically occurs on the earlobes, neck, wrists, and infraumbilical area. We describe a newly recognized presentation for this common childhood ACD--on the posterior thighs--which we have termed the school chair sign.

Child↗
PubMed2004

Etiology of hand dermatitis among patients referred for patch testing.

BACKGROUND: Hand dermatitis affects many people and has numerous causes. Few reports have looked at the etiology of hand dermatitis across broad demographics. OBJECTIVES: The purposes of this investigation were to (1) determine the causes of hand dermatitis in the population patch-tested at a dermatologic referral clinic, (2) report occupations frequently associated with hand dermatitis, and (3) indicate which substances were the more common allergens among individuals evaluated by patch testing for hand dermatitis. METHODS: A retrospective analysis of patch-test data on 1,034 patients who were evaluated during an 8-year period was performed. RESULTS: Hand dermatitis affected 32% of all patients who underwent patch testing. Allergic contact dermatitis was diagnosed most often (54.4%), followed by irritant contact dermatitis (27.4%). Among women, irritant contact dermatitis of the hands peaked in the third decade and then diminished whereas allergic contact dermatitis of the hands remained fairly constant among patients between 21 and 60 years of age. In contrast, irritant contact dermatitis and allergic contact dermatitis in men peaked in the fifth decade of life. In both genders, hand dermatitis was rare among those 20 years of age or younger and among those 61 years of age or older. Fifty-six percent of hand dermatitis was related to occupation. Health care workers were most often affected by occupational hand dermatitis. The most common allergens for both occupational and non-occupational hand dermatitis were quaternium-15, formaldehyde, thiuram mix, and carba mix. CONCLUSIONS: Since more than half of hand dermatitis cases may be related to occupation, a thorough history should be taken by a knowledgeable clinician. Potentially relevant allergens in the workplace must be identified and tested. These allergens may not be contained in standard trays.

Adult↗
PubMed2004

North American Contact Dermatitis Group patch-test results, 2001-2002 study period.

BACKGROUND: Allergic contact dermatitis is a significant cause of cutaneous disease affecting many individuals in the home and at the workplace. Patch testing is the most worthwhile diagnostic tool for the evaluation of patients with suspected allergic contact dermatitis. OBJECTIVE: This study reports the results of patch testing from January 1, 2001, to December 31, 2002, by the North American Contact Dermatitis Group (NACDG). METHODS: Patients were tested with an extended screening series of 65 allergens. A standardized patch-testing technique was used. Data from these patients were recorded on a standardized computer entry form and analyzed. RESULTS: Sixty-five allergens were tested on 4,913 patients. The top 10 allergens remain the same in this study period as in the 1999-2000 study period: nickel sulfate (16.7%), neomycin (11.6%), Myroxilon pereirae (balsam of Peru) (11.6%), fragrance mix (10.4%), thimerosal (10.2%), sodium gold thiosulfate (10.2%), quaternium-15 (9.3%), formaldehyde (8.4%), bacitracin (7.9%), and cobalt chloride (7.4%). Of the 4,913 patients tested, 69% had at least one positive allergic patch-test reaction. Of all patients, 15.8% had occupation-related dermatitis; 15.4% were determined to have irritant contact dermatitis, and 11.1% of the 15.4% had a relevant reaction to an occupational irritant. Of all patients tested, 16.7% had a relevant reaction to an allergen not in the NACDG standard series, and 5.5% had a relevant reaction to an occupational allergen not in the standard series. CONCLUSION: Our findings once again reinforce the need for a more comprehensive group of diagnostic allergens than those found in the standard screening kits. The usefulness of patch testing is enhanced when a greater number of allergens are tested, especially nonstandard allergens occupationally encountered.

Adolescent↗
PubMed2003

Quality of life in patients with allergic contact dermatitis.

BACKGROUND: Allergic contact dermatitis (ACD), a common dermatological disorder, often results in ongoing disease and disability. However, relatively little has been published quantifying the quality of life (QoL) of patients with ACD. OBJECTIVES: This study was conducted to investigate the impact of ACD on QoL and explore prognostic factors that influence outcomes. METHODS: A total of 428 subjects with ACD were, at varying times after diagnosis, mailed a QoL questionnaire modified from Skindex-16 to include an additional 5 items pertaining to occupational impact. The QoL scores were correlated with subject demographics, disease characteristics, and management techniques to ascertain factors that impact QoL in subjects with ACD. RESULTS: The response rate was 35%, with 149 subjects returning the postal survey. Responders reported being bothered most by itching, skin irritation, and persistence of the condition. Of the four scales included in the QoL questionnaire, the emotions scale had the worst composite QoL score, followed by symptoms, functioning, and occupational impact. Patients with ACD of the face were significantly more bothered by the appearance of their skin. Hand involvement and occupationally related ACD were associated with worse QoL scores within the occupational impact and functioning scales. Subjects that had changed jobs because of ACD had more severe QoL impairment than any other group analyzed, with significantly worse scores on 17 of the 21 QoL items. A history of atopic eczema seemed to impart improved outcomes on patients with ACD, and these subjects were less worried about being fired from their jobs. Subjects diagnosed by patch testing more than 36 months after disease onset seemed to have worse QoL scores than those diagnosed earlier in the natural history of the disease. Patients diagnosed by patch testing within the last 6 months had the worst QoL scores, while the best outcomes were reported in subjects patch tested 6 to 12 months ago. A slight decline in QoL was observed 12 months after patch testing, but scores did not diminish back to the level seen immediately after diagnosis. CONCLUSIONS: ACD has an appreciable effect on QoL, especially when it affects the hands, the face, or is occupationally related. Of the four scales included in our study, the emotions scale suffered the greatest effect. Emotional impact is therefore an important measure of QoL in ACD patients. Outcomes in patients with ACD were improved by early diagnosis and subjects enjoyed their best QoL at 6 to 12 months after patch testing. However, individuals who elected to change jobs because of their skin condition reported significantly worse QoL than those who retained their current positions.

Adult↗
PubMed2003

The detection of clinically relevant contact allergens using a standard screening tray of twenty-three allergens.

BACKGROUND: The current standard tool for diagnosing allergic contact dermatitis (ACD) in the United States is the T.R.U.E. test panels, which consist of 23 allergens. Previous studies have raised concern regarding the adequacy of these panels in fully assessing patients with possible ACD. OBJECTIVE: We sought to examine the use of the T.R.U.E. test allergens as the primary diagnostic method for detecting ACD. METHODS: A retrospective analysis of all patients with possible ACD who presented to the University of Kansas' Section on Occupational and Contact Dermatitis in Kansas City, Kansas, and subsequently underwent patch testing from January 1, 1995, to December 31, 2001. Patients with positive allergic reactions were stratified into 3 groups: (1) reactions only to allergens on the T.R.U.E. test; (2) reactions only to allergens not present on the T.R.U.E. test; and (3) reactions to allergens on the T.R.U.E. test and additional allergens. These 3 groups were further analyzed to assess clinical relevance. RESULTS: Of the 898 patients who were patch tested, 616 (68.6%) had at least 1 positive allergic reaction. Among these 616 patients, 25.5% would have been fully evaluated using the T.R.U.E. test allergens only. Of the remaining patients, 22.4% would not have had any of their allergens detected and 52.1% would have only been partially evaluated had only the T.R.U.E. test allergens been used. Similar percentages were observed when only patients with clinically relevant reactions were included. CONCLUSIONS: In our study, the current T.R.U.E. test series of 23 allergens would have completely identified all allergens in only 25.5% of patients and clinically relevant allergens in 28% of patients. Expanding the number of allergens used according to a patient's environment and history will lead to improved outcome in the treatment and prevention of ACD.

Allergens↗
PubMed2003

Tacrolimus ointment 0.1% in the treatment of nickel-induced allergic contact dermatitis.

BACKGROUND: Tacrolimus is a macrolactam that prevents the transcription of messenger RNA for various inflammatory cytokines in both helper T cells (types 1 and 2) (T(H)1 and T(H)2). It is currently approved for the treatment of moderate to severe atopic dermatitis, a Th2-mediated disease, in children and adults. OBJECTIVE: We sought to evaluate the safety and efficacy of tacrolimus ointment 0.1% in the treatment of nickel-induced allergic contact dermatitis, a T(H)1-mediated disease. METHODS: This was a double-blind, randomized, vehicle-controlled, bilateral paired comparison study to assess the safety and efficacy of topical tacrolimus (Protopic, Fujisawa Healthcare Inc, Deerfield, Ill) ointment 0.1% in the treatment of allergic contact dermatitis induced by nickel sulfate. Volunteers were individuals with known hypersensitivity to nickel. Reactivity to nickel was graded both as the investigator's global assessment and total signs and symptoms, which consisted of the cumulative grade from 0 to 4 for each of the following parameters: erythema, induration, vesiculation, and pruritus (range of scores: 0-16). Reactivity was assessed in the per-protocol group at 1 and 2 weeks after beginning treatment with study drug and control. Adverse events were assessed in the intent-to-treat population. RESULTS: Of the 19 volunteers who completed the study (per protocol), 18 had an improvement in total signs and symptoms with tacrolimus versus 10 patients with the vehicle. Of patients, 80% had an improvement in the investigator's global assessment score on the tacrolimus-treated site versus 30% of patients on the placebo-treated site. Overall, tacrolimus was more effective than placebo in ameliorating the nickel reaction. Although the tacrolimus treated site was clear or almost clear in a greater number of individuals at week 1, this difference did not become significant until the second week of the study. Other than application site burning in 25% of volunteers, no significant adverse events were noted in the intent-to-treat population. CONCLUSION: Topical tacrolimus (Protopic, Fujisawa Healthcare Inc) ointment 0.1% may be an option for the treatment of allergic contact dermatitis induced by nickel.

Administration, Topical↗