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Biomedical subjects

E F Sherertz

Publications and source records attributed to E F Sherertz.

At least 37 records · Page 2Linked to original sources
PubMed1998

The incidence of allergic contact dermatitis in patients with psoriasis vulgaris.

BACKGROUND: Contact dermatitis is said to be rare in psoriasis patients, possibly because of accelerated epidermal turnover, the isomorphic (Koebner) response, and lymphocyte functional alterations. OBJECTIVE: To identify contact allergy in patients with psoriasis. METHODS: A written questionnaire was completed by 100 patients with psoriasis about contact history, flare factors for psoriasis, topical skin care, medications, and occupational/hobby exposures. Of these patients, 20 agreed to be patch tested with a standard screening series (Hermal) and a 20-item psoriasis patch-test series that included ingredients that might be found in topical psoriasis products. RESULTS: Of the 100 patients, eight suspected a topical medication caused a reaction that worsened their psoriasis, 29 gave a history of atopy, 11 reported reactions to metal jewelry, and 29 reported an allergy to poison ivy. Patch-test results identified four of the 20 patients with six positive patch tests to the materials tested: three of the six positive tests were interpreted as relevant to the patient's psoriasis (coal tar, ethylenediamine and dithranol), two patients tested positive to nickel and one to thimerosal. Five patients had irritant reactions to dithranol. CONCLUSIONS: In this small study, 20% of self-selected psoriasis patients had positive allergic reactions on patch testing. A screening contact and atopic history in psoriasis patients may help to identify a subset of patients who could benefit from a search for more relevant contact allergens with patch test evaluation. This could improve treatment strategies and possibly reduce disability.

Dermatitis, Allergic Contact↗
PubMed1998

An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis.

BACKGROUND: A previous retrospective study indicated that patch testing is cost-effective and well accepted by patients. OBJECTIVE: The objective of this observational prospective study was to show the cost-effectiveness of patch testing in patients suspected of allergic contact dermatitis (ACD) and to determine the order in which different severity groups rank in terms of cost-effectiveness. METHODS: This observational study was conducted in 567 patients from 10 investigator sites over a period of 1 year. All patients with a suspicion of contact allergy who exhibited at least moderate disease activity were included in the study and were stratified according to disease severity and whether or not they were patch tested. In each severity category, the cost-effectiveness of patch testing was evaluated. Patients who were ruled out for contact allergy by the first 6 months after admission were excluded. A validated dermatology-specific quality of life instrument was administered to all the patients at entrance into the study and at 6 and 12 months after that. The cost-effectiveness analysis is shown using a decision analysis model. RESULTS: Patch testing was performed on 22% of patients with mild disease, 41% of patients with moderate disease, and 50% of patients with severe disease. As a result of changes made in their lifestyle, 66% in the patch-tested group and 51% in the non-patch-tested group reported 75% or more improvement in disease symptoms after 6 months. Early confirmation of diagnosis helped reduce the prediagnosis costs of treatment, which was mostly based on preliminary diagnosis. The greatest quality of life benefits from patch testing, relative to no patch testing, occurred in subjects with recurrent or chronic ACD. CONCLUSION: Patch testing is most cost-effective and reduces the cost of therapy in patients with severe ACD.

Chronic Disease↗
PubMed1997

Evaluation of previously patch-tested patients referred to a contact dermatitis clinic.

BACKGROUND: One of the frustrations for clinicians who use patch testing is the patient in whom screening patch tests does not yield a relevant result that improves patient outcome. Is it allergic contact dermatitis? Was an allergen missed? Is the screening allergen relevant after all? OBJECTIVE: The purpose of this study was to look at the subset of patients referred to a contact clinic who had previously undergone patch testing to seek answers to these questions for this population. METHOD: The charts of all 119 physician-referred patients seen in the contact clinic from February through August 1995 were reviewed. Information was gathered about the sites of dermatitis, previous patch testing results, current patch testing results (using the North American Contact Dermatitis Group series and supplemental allergens when indicated), and final diagnosis. RESULTS: Forty-three patients had previously undergone patch testing. Nineteen had been tested with the True Test and 24 with the screening series presumed to be Hermal. The sites of skin involvement were similar to the untested group (approximately 1/3 hands, 1/3 face/exposed sites, and 1/3 other). Eighteen pretested patients(42%) had been reported to have one or more positive patch tests, with the most frequently reported allergens, including neomycin (4), quaternium 15 (3), Balsam of Peru (3), fragrance (2), and formaldehyde (2). On repeat testing, 77% of the previous positives were again positive, and many were thought to be relevant. Nine of the 18 had additional allergens deemed relevant. Twenty-five pretested patients had been negative on initial patch testing. Eighteen of the 25 (72%) had positive allergens on repeat testing, and most were thought to be relevant. There were 17 reactions to screening allergens and 16 reactions to additional allergens or products. Variations noted with initial negative testing included use of systemic corticosteroids, patient self-removal of tests, and single 48-hour readings. Overall, 27 of 43 pretested patients (63%) were found to have relevant additional allergens with contact clinic evaluation. Screening allergens were underrecognized as being relevant by clinicians in practice. CONCLUSIONS: Patients suspected of having an allergic component to their dermatitis should be patch tested with the screening series of allergens. Interpretation of the relevance of the allergens and appropriate avoidance is a challenge. If screening allergen patch testing is negative or believed to be not relevant in a patient with persistent dermatitis, there may be a high yield on further patch test evaluation.

Dermatitis, Allergic Contact↗
PubMed1997

Common patch test allergens: general guidelines for avoidance.

Contact dermatitis is a very common diagnosis in the dermatology clinic. Simplified information offers a good starting point for patient education and instruction about avoidance measures. Using the general guidelines proposed here can be useful for the most common allergens, and will help motivate both the patient and providers to be active participants in solving the puzzle of allergic contact dermatitis.

Aged↗
PubMed1997

Occupational dermatitis transferred with job duties.

Astroemeria is an increasingly common cause of allergic contact dermatitis. We report a case of occupational contact dermatitis that was transferred with job duties. When advising patients about their risk, it is advisable to discuss the risk to others in the setting as well.

Allergens↗
PubMed1997

Estimating dilutions for patch testing skin care products: a practical method.

When patch testing, it is helpful to patch test with the patient's own topical products. However, the thickness (viscosity) of the product often prevents easy measurement for dilution. A method of estimating volume: volume dilutions that requires minimal investment in supplies is presented. This method is only applicable to personal products and is not suitable for industrial or household chemicals.

Allergens↗
PubMed1996

Aeroallergen patch testing for patients presenting to contact dermatitis clinics.

BACKGROUND: The role of aeroallergens in the production of allergic contact dermatitis or "allergic contact dermatitis-like" atopic dermatitis is controversial. Although techniques and allergens lack standardization, most studies find positive patch test results in 30% to 40% of patients with atopic dermatitis. OBJECTIVE: Our purpose was to determine the prevalence and clinical significance of positive aeroallergen patch tests in patients undergoing standard patch testing for suspected "nonaeroallerge" allergic contact dermatitis. METHODS: One hundred three consecutive patients referred to three university patch test clinics for patch testing were alos patch tested with six common aeroallergens in glycerine-dust, mold, cat epithelium, tree, grass, and weed-as well as with a glycerine control. Patches were removed at 48 hours. Readings were performed at this time and at 3 to 7 days after initial application. RESULTS: As determined by history, these 103 patients included 16 patients with both atopic dermatitis and mucosal atopy, 10 patients with atopic dermatitis only, 22 patients with mucosal atopy only, and 55 patients with neither atopic dermatitis nor mucosal atopy. Allergic reactions were seen to one aeroallergen in five patients (three with atopic dermatitis and mucosal allergy, and two with no history of atopy). The prevalence (3 of 16 [18.8%]) of reactions in patients with both atopic dermatitis and mucosal allergy was significantly greater than the prevalence (2 of 87 [2.3%]) in patients with only one or neither of these two atopic disorders (p = 0.02). None of these aeroallergen contact hypersensitivities were deemed significant in the patients' current dermatitis. However, reactions were of past relevance in two of the three patients with atopic dermatitis and mucosal allergy. CONCLUSION: In this referral group, none of the six common aeroallergens tested was relevant in the origin of suspected "nonaeroallergen" allergic contact dermatitis. This study suggests that aeroallergen patch testing is of little use in the evaluation of patients referred for routine patch testing for suspected "nonaeroallergen" allergic contact dermatitis. Similar but larger studies inclusive of the assessment of relevance, as well as masked controlled clinical trials assessing the effect of aeroallergen exposure and avoidance, are needed to evaluate this issue more fully.

Adult↗
PubMed1996

A retrospective evaluation of patch testing in patients diagnosed with allergic contact dermatitis.

One reason given by clinicians for not using patch testing in patients with dermatitis is that it may not improve the treatment outcome. The main objectives of this retrospective study were to determine the frequency of use of patch testing as an aid to the diagnosis of allergic contact dermatitis (ACD), to determine the ACD-related costs before and after diagnosis of the disease, and to determine the benefit of the diagnosis of ACD, with or without patch testing, to the patient's treatment outcome. This study will also provide definite direction for a prospective outcome study. Medical records of 270 patients with ACD were utilized retrospectively to study the benefit of patch testing. Patch testing was performed on 56 percent of these patients. Patch testing was found to bring about a larger decrease in the disease severity index and percentage disease activity from prediagnosis to postdiagnosis than diagnosis without patch testing. In the group of patients with a prediagnosis disease duration of two months to one year, the postdiagnosis duration was considerably less for those patch tested and treated than those that were treated without patch testing. Patch testing was found to be the most cost-effective in patients with a disease duration of two months to one year.

Adult↗
PubMed1996

Allergic contact dermatitis from azathioprine.

A 51-year-old production mechanic for a pharmaceutical company complained of a dermatitis involving his hands. The onset of the eruption coincided with when he was placed on the production packing line for azathioprine tablets. Patch testing showed a positive allergic reaction only to azathioprine diluted in petrolatum. A pharmaceutical product such as azathioprine may need to be considered as a cause for allergic contact dermatitis in patients with a history of exposure during the manufacturing process.

Azathioprine↗
PubMed1996

Contact dermatitis in the textile industry: a review of 72 patients.

BACKGROUND: Occupational skin disease can cause significant morbidity in textile industry workers. Both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) have been reported. OBJECTIVE: The purpose of this study was to characterize and determine the relative frequency of work-related ACD and ICD in textile workers. METHODS: Seventy-two textile industry workers seen during a 5-year period were evaluated for possible work-related contact dermatitis. All patients underwent patch testing with a screening series. Many patients (70%), depending on occupational exposures, also underwent testing with a textile dye and finish series and additional patch tests of specific workplace materials. RESULTS: Twenty-one patients (29%) were diagnosed as having a predominantly work-related ACD. Relevant allergens included textile dyes, textile finishes, and rubber allergens. Twenty-seven patients (38%) were diagnosed as having primarily a work-related ICD. Five patients (7%) were believed to have combined work-related ACD and ICD. Nineteen patients (26%) were believed to have purely non-work-related allergens, irritants, atopy, or other dermatoses as the major factors in their skin disease. The hands were the most common site of involvement. Of the 40 patients with occupational exposure to raw textile products 36 (90%) had a work-related dermatitis and only 4 (10%) had a non-work-related dermatitis. CONCLUSION: In the 72 textile workers evaluated in our clinic, occupational exposures were an important cause of skin disease (74% in our series). Textile workers with job exposures to raw textile materials are at highest risk for work-related dermatitis. Textile industry workers with essentially no textile product exposure were more likely to have non-work-related dermatoses. ICD was only slightly more frequent than ACD. The hands were the most common site of involvement. Because relevant allergens (work-related and non-work-related) were more common than expected, we emphasize the importance of patch testing with standard screening allergens in the diagnostic evaluation of patients with dermatitis who work in the textile industry. In addition, textile dye and finish allergens should also be tested in this patient population, particularly those patients with any textile product exposure.

Adult↗
PubMed1996

Patch testing in an aged population without dermatitis: high prevalence of patch test positivity.

BACKGROUND: Epidermal immune function has been observed to decline in the aged. OBJECTIVE: The purpose of this study was to determine the prevalence and relevance of patch test reactivity in an aged population without dermatitis and compare this with patch test reactivity in healthy younger volunteers. METHODS: Patch testing with the North American Contact Dermatitis Group standard tray was performed on 82 healthy volunteers ranging in age from 68 to 87 years (mean age, 75 years), and the results were compared with those of 41 healthy younger volunteers (mean age, 24 years). A questionnaire regarding cutaneous symptoms was administered to both groups. RESULTS: Thirty subjects in the older population (37%) had one or more positive patch test results compared with 6 members of the control group (15%) (P = .01). Common sensitizers in the older group included balsam of Peru (7[9%]), fragrance (8[10%]), neomycin (6[7%]), nickel (5[6%]), and methylchloroisothiazolinone/methylisothiazolinone (3[4%]). A history of severe pruritus (without dermatitis) was associated with positive patch test results to balsam of peru and nickel. CONCLUSION: A high prevalence of positive patch test results in an aged population without dermatitis was observed. Factors contributing to to the high prevalence of patch test reactivity in the aged population may include cumulative exposure to potential allergens over time, a preserved ability to develop contact allergy, and altered percutaneous absorption. Patch testing in the aged must be interpreted carefully because the results may relate to past rather than present relevance.

Adult↗
PubMed1994

Is allergic contact dermatitis being overlooked?

Contact dermatitis is very common and is among the top 20 reasons for a patient to visit a physician. This article reviews the basic features of irritant and allergic contact dermatitis and provides case examples. We emphasize the use of patch testing to diagnose specific allergens in allergic contact dermatitis. Contact dermatitis is important to recognize since there are prevention and intervention strategies that may be of great help to the patient. Accurate diagnosis and prevention of contact dermatitis would have a positive impact on medical care costs and job productivity.

Adult↗