Fitzpatrick's Dermatology in General Medicine.

I. Leonard Bernstein, MD; James T. Li, MD, PhD; David I. Bernstein, MD; Robert Hamilton, PhD, DABMLI; Sheldon L. Spector, MD; Ricardo Tan, MD; Scott Sicherer, MD; David B. K. Golden, MD; David A. Khan, MD; Richard A. Nicklas, MD; Jay M. Portnoy, MD; Joann Blessing-Moore, MD; Linda Cox, MD; David M. Lang, MD; John Oppenheimer, MD; Christopher C. Randolph, MD; Diane E. Schuller, MD; Stephen A. Tilles, MD; Dana V. Wallace, MD; Estelle Levetin, PhD; and Richard Weber, MD

/pdf/allergy-diagnostic-testing-an-updated-practice-parameter-21api4satq.pdf

Allergy diagnostic testing: An updated practice parameter

Bailey and Love's Short Practice of Surgery

Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reactions to NSAIDs. The document proposes also practical algorithms for the diagnosis of specific types of NSAIDs hypersensitivity (which include drug provocations, skin testing and in vitro testing) and provides, when data are available, evidence-based recommendations for the management of hypersensitive patients, including drug avoidance and drug desensitization.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/all.12260

Classification and practical approach to the diagnosis and management of hypersensitivity to nonsteroidal anti-inflammatory drugs

It should be remembered that sexually transmitted infections may present with symptoms and signs not immediately referable to the genital tract. All practitioners should be aware of the changes in incidence and prevalence of these important infections.

Sexually transmitted infections.

Background. Among various surgical therapies for replenishment of melanocytes in recalcitrant and stable vitiligo, punch skin grafting (PSG) and suction blister epidermal grafting (SBEG) are the simplest ones. Literature is lacking on a comparison of both.



Objective. We compared the results of both techniques in small patches of vitiligo.



Methods. Fifty stable vitiligo (focal, segmental, and generalized) patients were selected for study. One patient was lost to follow-up and excluded. PSG was done in 48 patches of 25 patients and SBEG was done in 38 patches of 24 patients. All patients were kept on psoralen ultraviolet-A (PUVA)/psoralen sunrays (PUVASOL). Results were evaluated after a follow-up of 4–7 months.



Results. Thirty-two (67%) patches of the PSG group and 31 (82%) patches of the SBEG group showed greater than 75% pigmentation. The difference in both groups was not statistically significant. Cobblestone appearance (23%) over the recipient area (RA) and superficial scarring of the donor area (DA) (100%) were seen in PSG. No serious complications were seen in both groups.



Conclusion. Both techniques are simple and effective, however, SBEG gives cosmetically better and rapid results.

Suction blister epidermal grafting versus punch skin grafting in recalcitrant and stable vitiligo.

The pattern of sexually transmitted diseases (STDs) at Rohtak Medical College, based on retrospective data for the period from January 2001 to December 2006, was compared with the findings of an earlier study done at the same place and with other studies available in the literature. This study included a total of 1542 patients with STDs. The male: female ratio was 5.17:1. Most of the patients were in the third decade of their lives. Herpes genitalis was the most common STD (31.26%), followed by condyloma acuminata (27.30%), syphilis (16.67%), gonorrhea (12.06%), and other diseases.

Changing trends of sexually transmitted diseases at Rohtak

Background: Narrow-band UVB is the most innovative steroid sparing treatment in atopic dermatitis. There are studies showing efficacy of Narrow-band UVB in childhood atopic dermatitis, but there is lack of clinical trials in the literature determining the length of remission. Therefore, we sought to highlight its efficacy, safety and its post-treatment efficacy in childhood atopic dermatitis. Objective: To assess the clinical efficacy, safety of Narrow-band UVB in the treatment of paediatric atopic dermatitis and length of remission during 2 years of post-treatment follow-up. Methods: Thirty children (4-14 years) having moderate to severe AD (SCORAD index > 25) were enrolled for 12 weeks. Narrow-band UVB phototherapy was administered twice a week on non-consecutive days for three months. SCORAD index was calculated by the same dermatologist at baseline, 6th, 12th, 18th and 24th treatment session. Secondary outcomes were measured using visual analog scale for pruritus and sleep loss. Patients were also followed-up for 2 years to know the length of remission after end of therapy. Results: There was a significant reduction in SCORAD index at 6th, 12th, 18th and 24th treatment session in comparison to baseline. This improvement in SCORAD was also maintained during the 2 years of post-treatment follow-up period. Consequently, pruritus and sleep loss improved significantly from baseline to end of therapy and even during the 1st and 2nd year of follow-up. Study limitation: Open-label trial without control group. Conclusions: Narrow-band UVB is an efficacious and safe modality of treatment in childhood atopic dermatitis with good therapeutic index and minimal side effects.

https://www.scielo.br/pdf/abd/v92n6/0365-0596-abd-92-06-0801.pdf

Narrowband UV-B phototherapy in childhood atopic dermatitis: efficacy and safety.

A 9-year-old boy presented with asymptomatic papulonodular lesions on the left half of the chin of 3-years duration. On examination he had small papular lesions on the left chin varying in size from 1 to 5 mm. An additional lesion on the margin of the lip was 14 mm in diameter. The overlying skin was normal. Lesions were firm, nontender, and fixed to the skin. Histopathologic examination of the biopsy specimen revealed characteristic features of eccrine spiradenoma. A literature search produced reports of 10 cases of linear/zosteriform spiradenoma. Of these, five were in children or adolescents. We report this patient because of the rare occurrence of this presentation.

Multiple eccrine spiradenomas in zosteriform distribution in a child.

Fifty patients of both sexes with clinically suspected pompholyx were patch tested with the Indian Standard Patch Test Battery approved by the Contact & Occupational Dermatosis Forum of India (CODFI). Most of these patients were young adults between 20-39 years of age with a mean age of 30 years. The mean duration of symptoms was 4 years. The occupational profile of the patients included students (20%), housewives (16%), housewives engaged in farming (12%), labourers (12%), farmers (12%) and paramedical workers (6%). The miscellaneous group, including salesmen, teachers and photographers, accounted for the remaining 22%. The clinical patterns of presentation of pompholyx included cheiropompholyx (60%), cheiropompholyx and podopompholyx (36%) and podopompholyx alone (4%). Patch test analysis of these patients revealed that, out of the 50 subjects tested, 20 (40%) reacted to one or more allergens. Nickel sulphate was the commonest offending allergen (14%) followed by potassium dichromate and phenylene diamine and nitrofurazone (8% each), fragrance mix (6%) and cobalt chloride (4%), in descending order of frequency. Hence, patch testing may be considered for all patients with recurrent episodes of pompholyx as allergic contact dermatitis may be relatively common in such patients and the avoidance of offending allergens may be of substantial benefit to these patients.

Role of Contact Allergens in Pompholyx

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