Atopic Dermatitis

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Marijuana hypersensitivity might be more common than previously thought, according to the results of a case series.

Though there are only a few case reports in the literature, "Marijuana allergy, I think, is fairly common," said lead investigator Dr. Gordon Sussman, acting division director of clinical allergy and immunology at the University of Toronto. Even so, "It's something physicians don't really generally ask about. People should consider it in the diagnosis of rhinitis [and other allergic symptoms], and even in people that have asthma and anaphylaxis."

Photo credit: ©ron hilton/iStockphoto.com

The 17 patients who were included in the series reported that marijuana gave them runny noses or other problems; all ended up having positive marijuana skin prick test results, he reported. One patient in the series had an anaphylactic reaction after drinking marijuana tea.

That was the first patient in whom Dr. Sussman diagnosed a marijuana allergy. "I asked him in a detailed history what it could have been, and he actually had drunk marijuana tea. We knew at that point he had an IgE-mediated reaction to marijuana," he said.

Curiosity piqued, and Dr. Sussman began asking allergy patients about marijuana use and reactions. A significant percentage reported symptoms from both contact and inhalation.

To confirm the diagnosis, he and his colleagues did skin-prick tests on the 17 patients between 21 and 58 years old, mostly men. They extracted buds or flowers in 5 mL of water for 15 minutes and pricked beneath drops placed on patients' skin.

After 15 minutes, the 17 patients had wheals of 4-19 mm and surrounding flares. Fifteen presented with inhalation symptoms, including rhinitis and conjunctivitis, periorbital angioedema, wheezing, sinusitis, and throat swelling. Thirteen also reported hives from contact.

The anaphylaxis patient presented with anxiety, chest tightness, wheezing, GI cramping, and vomiting after drinking the tea.

"I don't think it's a contaminant; I'm pretty sure it's an allergen in the marijuana they are reacting to," Dr. Sussman said, adding that such reactions shouldn't be a surprise because "marijuana is a weed, and weeds are generally known to be allergenic."

Asking about marijuana use and past reactions should be a routine part of allergy work-ups, especially with expanding medical marijuana use. "People could actually be sensitized to marijuana and have a serious reaction. It's important for people to recognize this," Dr. Sussman said.

The researchers' next step is to identify the actual allergens responsible for the reactions using a marijuana extract from a U.S. federal laboratory, serum from positive patients, and Western blot assays.

There was no outside funding for the study. Dr. Sussman said he had no disclosures.

SAN FRANCISCO – Children's eczema and parents' confidence in managing it both improved when parents were given eczema action plans with stepwise instructions for treatment according to severity, a small study has shown.

The idea for the study came from asthma management, in which personalized action plans are routinely given to parents to help manage childhood asthma, according to lead author Jillian Rork, a third-year medical student at Harvard Medical School, Boston.

The eczema action plans (EAPs) developed by Ms. Rork and her colleagues at Children's Hospital Boston and Seattle Children's Hospital divided treatment into three "zones." The green zone comprises daily skin care, including use of moisturizers and cleansers, for when children have only mild redness or irritation. The yellow zone includes topical steroids for when parents begin to notice a flare, and the red zone is for severe redness, itching, and oozing, which could involve more potent topical steroids or other medications.

"The physician can actually fill in the blank as to which medication to use," Ms. Rork explained. That decision depends on the level of the child's underlying disease. The approach is "very useful, not only for allergists but for ... the whole gamut. That was the goal, to have [the EAP be] very applicable," Ms. Rork said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the study, parents of 35 children ranging in age from 4 months to 17 years (mean 4 years), were given EAPs in a tertiary allergy program. Parents completed a survey regarding their child’s eczema at baseline and then again at 3-12 months' follow-up.

At follow-up, the number of parents who rated their child’s eczema as severe dropped from 51% at baseline to 3%, a significant difference. The percentage of children with mild eczema increased from 3% initially to 57%, also a significant difference. Itching and scratching levels fell in 60% of children, and sleep improved in 65%. Overall, 80% of parents said their child's eczema was less severe.

Meanwhile, 67% of parents said the EAP contributed to the improvements, and 86% said it clarified their child's medication regimen. The number of parents saying they were comfortable managing their child's eczema rose from 57% to 86%, a significant change.

Many parents said they gave copies of the EAP to day care providers or school nurses.

The approach "works really well for kids who have mild eczema - because they still need to have a green and yellow zone, and sometimes the red zone is the same - and [in] kids who have really severe skin who're going to have very different treatment methods in each zone," Ms. Rork said.

Although the utility of asthma action plans is widely supported in the literature, she noted, her study is the first to demonstrate utility for eczema.

Ms. Rork and her colleagues are considering an electronic version of the form that would allow clinicians to type instructions and print out the form for parents, in the same way that asthma action plans work in most offices. The researchers are also considering a similar approach to eczema for older patients. "We found it useful in kids. Maybe it can apply in adults, too," Ms. Rork said.

Ms. Rork said she has no disclosures.

SAN FRANCISCO – Children's eczema and parents' confidence in managing it both improved when parents were given eczema action plans with stepwise instructions for treatment according to severity, a small study has shown.

The idea for the study came from asthma management, in which personalized action plans are routinely given to parents to help manage childhood asthma, according to lead author Jillian Rork, a third-year medical student at Harvard Medical School, Boston.

The eczema action plans (EAPs) developed by Ms. Rork and her colleagues at Children's Hospital Boston and Seattle Children's Hospital divided treatment into three "zones." The green zone comprises daily skin care, including use of moisturizers and cleansers, for when children have only mild redness or irritation. The yellow zone includes topical steroids for when parents begin to notice a flare, and the red zone is for severe redness, itching, and oozing, which could involve more potent topical steroids or other medications.

"The physician can actually fill in the blank as to which medication to use," Ms. Rork explained. That decision depends on the level of the child's underlying disease. The approach is "very useful, not only for allergists but for ... the whole gamut. That was the goal, to have [the EAP be] very applicable," Ms. Rork said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the study, parents of 35 children ranging in age from 4 months to 17 years (mean 4 years), were given EAPs in a tertiary allergy program. Parents completed a survey regarding their child’s eczema at baseline and then again at 3-12 months' follow-up.

At follow-up, the number of parents who rated their child’s eczema as severe dropped from 51% at baseline to 3%, a significant difference. The percentage of children with mild eczema increased from 3% initially to 57%, also a significant difference. Itching and scratching levels fell in 60% of children, and sleep improved in 65%. Overall, 80% of parents said their child's eczema was less severe.

Meanwhile, 67% of parents said the EAP contributed to the improvements, and 86% said it clarified their child's medication regimen. The number of parents saying they were comfortable managing their child's eczema rose from 57% to 86%, a significant change.

Many parents said they gave copies of the EAP to day care providers or school nurses.

The approach "works really well for kids who have mild eczema - because they still need to have a green and yellow zone, and sometimes the red zone is the same - and [in] kids who have really severe skin who're going to have very different treatment methods in each zone," Ms. Rork said.

Although the utility of asthma action plans is widely supported in the literature, she noted, her study is the first to demonstrate utility for eczema.

Ms. Rork and her colleagues are considering an electronic version of the form that would allow clinicians to type instructions and print out the form for parents, in the same way that asthma action plans work in most offices. The researchers are also considering a similar approach to eczema for older patients. "We found it useful in kids. Maybe it can apply in adults, too," Ms. Rork said.

Ms. Rork said she has no disclosures.

SAN FRANCISCO – Children's eczema and parents' confidence in managing it both improved when parents were given eczema action plans with stepwise instructions for treatment according to severity, a small study has shown.

The idea for the study came from asthma management, in which personalized action plans are routinely given to parents to help manage childhood asthma, according to lead author Jillian Rork, a third-year medical student at Harvard Medical School, Boston.

The eczema action plans (EAPs) developed by Ms. Rork and her colleagues at Children's Hospital Boston and Seattle Children's Hospital divided treatment into three "zones." The green zone comprises daily skin care, including use of moisturizers and cleansers, for when children have only mild redness or irritation. The yellow zone includes topical steroids for when parents begin to notice a flare, and the red zone is for severe redness, itching, and oozing, which could involve more potent topical steroids or other medications.

"The physician can actually fill in the blank as to which medication to use," Ms. Rork explained. That decision depends on the level of the child's underlying disease. The approach is "very useful, not only for allergists but for ... the whole gamut. That was the goal, to have [the EAP be] very applicable," Ms. Rork said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

In the study, parents of 35 children ranging in age from 4 months to 17 years (mean 4 years), were given EAPs in a tertiary allergy program. Parents completed a survey regarding their child’s eczema at baseline and then again at 3-12 months' follow-up.

At follow-up, the number of parents who rated their child’s eczema as severe dropped from 51% at baseline to 3%, a significant difference. The percentage of children with mild eczema increased from 3% initially to 57%, also a significant difference. Itching and scratching levels fell in 60% of children, and sleep improved in 65%. Overall, 80% of parents said their child's eczema was less severe.

Meanwhile, 67% of parents said the EAP contributed to the improvements, and 86% said it clarified their child's medication regimen. The number of parents saying they were comfortable managing their child's eczema rose from 57% to 86%, a significant change.

Many parents said they gave copies of the EAP to day care providers or school nurses.

The approach "works really well for kids who have mild eczema - because they still need to have a green and yellow zone, and sometimes the red zone is the same - and [in] kids who have really severe skin who're going to have very different treatment methods in each zone," Ms. Rork said.

Although the utility of asthma action plans is widely supported in the literature, she noted, her study is the first to demonstrate utility for eczema.

Ms. Rork and her colleagues are considering an electronic version of the form that would allow clinicians to type instructions and print out the form for parents, in the same way that asthma action plans work in most offices. The researchers are also considering a similar approach to eczema for older patients. "We found it useful in kids. Maybe it can apply in adults, too," Ms. Rork said.

Ms. Rork said she has no disclosures.

NEW ORLEANS – Patch testing and prescription of fragrance-free skin care regimens might be indicated for children with moderate to severe atopic dermatitis.

In a study of 101 children, 88% of 54 with atopic dermatitis had a positive patch test result for one or more allergens, compared with 66% of 47 participants without atopic dermatitis, a statistically significant difference.

Dr. Elise Herro and her associates also found a correlation regarding the severity of both conditions. "EASI [Eczema Area and Severity Index] scores greater than 10 also statistically correlated with a higher probability of greater than 3 positive patch tests," she said at the annual meeting of the American Contact Dermatitis Society.

Study participants were 6-18 years old. Of the total 101 patients patch tested, 79 had at least one reactive test result. The 54 children classified as atopic met Hanifin-Rajka criteria.

Nickel, balsam of Peru, and fragrance were the most common allergens in the study. Positive reactions were significantly more common in children with atopy versus children without atopy for nickel (35% vs. 26%), balsam of Peru (20% vs. 2%), and fragrance mix (19% vs. 0%).

"We [also] found contact allergens whose high prevalence was unique to our patient population," said Dr. Herro of Rady Children's Hospital and the University of California, San Diego.

Dr. Herro and her colleagues identified children reactive to tixocortol pivalate, and para-tertiary-butylphenol-formaldehyde resin, a component of sports gear that can cause dermatitis. Positive tixocortol pivalate patch test reactions "could be related to the high percentage of atopic patients who have used topical corticosteroids."

Dr. Herro also reviewed previous studies that included patients with both atopic dermatitis and allergic contact dermatitis (Contact Dermatitis 2008;58:188-9; Arch. Dermatol. 2008;144;1329-36; and J. Clin. Aesthet. Dermatol. 2010;3:29-35).

This research "shows us that allergic contact dermatitis is commonly associated with atopic dermatitis, both when you look at frequency of allergic contact dermatitis among patients with atopic dermatitis and the frequency of atopic dermatitis among patients with allergic contact dermatitis," Dr. Herro said.

She said that she had no relevant financial disclosures.

NEW ORLEANS – Patch testing and prescription of fragrance-free skin care regimens might be indicated for children with moderate to severe atopic dermatitis.

In a study of 101 children, 88% of 54 with atopic dermatitis had a positive patch test result for one or more allergens, compared with 66% of 47 participants without atopic dermatitis, a statistically significant difference.

Dr. Elise Herro and her associates also found a correlation regarding the severity of both conditions. "EASI [Eczema Area and Severity Index] scores greater than 10 also statistically correlated with a higher probability of greater than 3 positive patch tests," she said at the annual meeting of the American Contact Dermatitis Society.

Study participants were 6-18 years old. Of the total 101 patients patch tested, 79 had at least one reactive test result. The 54 children classified as atopic met Hanifin-Rajka criteria.

Nickel, balsam of Peru, and fragrance were the most common allergens in the study. Positive reactions were significantly more common in children with atopy versus children without atopy for nickel (35% vs. 26%), balsam of Peru (20% vs. 2%), and fragrance mix (19% vs. 0%).

"We [also] found contact allergens whose high prevalence was unique to our patient population," said Dr. Herro of Rady Children's Hospital and the University of California, San Diego.

Dr. Herro and her colleagues identified children reactive to tixocortol pivalate, and para-tertiary-butylphenol-formaldehyde resin, a component of sports gear that can cause dermatitis. Positive tixocortol pivalate patch test reactions "could be related to the high percentage of atopic patients who have used topical corticosteroids."

Dr. Herro also reviewed previous studies that included patients with both atopic dermatitis and allergic contact dermatitis (Contact Dermatitis 2008;58:188-9; Arch. Dermatol. 2008;144;1329-36; and J. Clin. Aesthet. Dermatol. 2010;3:29-35).

This research "shows us that allergic contact dermatitis is commonly associated with atopic dermatitis, both when you look at frequency of allergic contact dermatitis among patients with atopic dermatitis and the frequency of atopic dermatitis among patients with allergic contact dermatitis," Dr. Herro said.

She said that she had no relevant financial disclosures.

NEW ORLEANS – Patch testing and prescription of fragrance-free skin care regimens might be indicated for children with moderate to severe atopic dermatitis.

In a study of 101 children, 88% of 54 with atopic dermatitis had a positive patch test result for one or more allergens, compared with 66% of 47 participants without atopic dermatitis, a statistically significant difference.

Dr. Elise Herro and her associates also found a correlation regarding the severity of both conditions. "EASI [Eczema Area and Severity Index] scores greater than 10 also statistically correlated with a higher probability of greater than 3 positive patch tests," she said at the annual meeting of the American Contact Dermatitis Society.

Study participants were 6-18 years old. Of the total 101 patients patch tested, 79 had at least one reactive test result. The 54 children classified as atopic met Hanifin-Rajka criteria.

Nickel, balsam of Peru, and fragrance were the most common allergens in the study. Positive reactions were significantly more common in children with atopy versus children without atopy for nickel (35% vs. 26%), balsam of Peru (20% vs. 2%), and fragrance mix (19% vs. 0%).

"We [also] found contact allergens whose high prevalence was unique to our patient population," said Dr. Herro of Rady Children's Hospital and the University of California, San Diego.

Dr. Herro and her colleagues identified children reactive to tixocortol pivalate, and para-tertiary-butylphenol-formaldehyde resin, a component of sports gear that can cause dermatitis. Positive tixocortol pivalate patch test reactions "could be related to the high percentage of atopic patients who have used topical corticosteroids."

Dr. Herro also reviewed previous studies that included patients with both atopic dermatitis and allergic contact dermatitis (Contact Dermatitis 2008;58:188-9; Arch. Dermatol. 2008;144;1329-36; and J. Clin. Aesthet. Dermatol. 2010;3:29-35).

This research "shows us that allergic contact dermatitis is commonly associated with atopic dermatitis, both when you look at frequency of allergic contact dermatitis among patients with atopic dermatitis and the frequency of atopic dermatitis among patients with allergic contact dermatitis," Dr. Herro said.

She said that she had no relevant financial disclosures.

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – After identifying a contact dermatitis trigger, a new online system provides a database of personal care products to recommend to patients as being safe to use or best to avoid.

CAMP (Contact Allergen Management Program) also produces a list of specific product ingredients that might spur cross-reaction, according to a presentation at the annual meeting of the American Contact Dermatitis Society.

Dr. Matthew J. Zirwas and other dermatologists developed CAMP based on their experience with CARD (Contact Allergen Replacement Database). The Mayo Clinic has leased CARD to the American Contact Dermatitis Society since 2002, but announced last year that they no longer wished to host the system.

"They offered to lease it to us for $1 million for 5 years. The [ACDS] board felt CARD was essential, but we couldn’t absorb the cost," Dr. Zirwas said.

A survey indicated that "CARD is a main reason that people become ACDS members," Dr. Zirwas said. "We decided the best approach would be to develop a system to give members the same basic functions as CARD."

The board of the American Contact Dermatitis Society saw this as an opportunity. "There were things about CARD that were improvable," said Dr. Zirwas of Ohio State University in Columbus.

A clickable list of common allergens, more specific cross-reactivity data, and the ability for manufacturers to update their product information are among the features of the new CAMP system (accessible at www.contactderm.org).

If a patient has a less-common allergy, the name of the allergen can be entered manually.

In the "Generating a List of Products" section, product categories relevant to the allergen can be selected. "We know that patients shop by brand. So we put all the eye makeup together, and it's easy for them to click on 'Clinique,' for example," Dr. Zirwas said. "You can print out the list, or the system will e-mail it to them as a .pdf" attachment.

After taking bids from several companies, the board chose Proximo, a company that also manages a database for the Personal Care Products Council.

"I spoke to the [council] about having companies update their own information each year, and the [manufacturers] liked the idea," Dr. Zirwas said. Active participation in a system that promotes patient safety is a benefit for them, he explained. Procter & Gamble, Unilever, Estée Lauder, and Mary Kay are all participating.

Multiple ingredient names for the same allergen can confound both dermatologists and patients. The CAMP system, however, searches for all relevant names unless the feature is turned off.

Some cross-reactors, such as formaldehyde, are well known. The challenge is that for more than 90% of ingredients, there are few or no data on cross-reactivity, Dr. Zirwas said. "In CARD, if there was any chance of cross-reactivity, it was in there. It was broadly defined, so the list was overrestrictive."

Allergens with less cross-reactivity evidence are included in CAMP based on feedback from an expert panel. "It is sort of a best-opinions approach."

Patient information is another feature of CAMP. The system features about three pages of narratives on specific allergens that are expected to grow over time, he said. For example, if a patient is allergic to balsam of Peru, information can be printed out that summarizes what is known about the allergen and how it can be avoided, including dietary recommendations.

ACDS membership ($300 per year) includes access to the CAMP database. For more information on how the system works, visit the CAMP instrument.

Dr. Zirwas said that he had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS – Custom patch testing is worthwhile as an adjunct to standard evaluation to identify allergens causing occupational dermatitis, according to a study of more than 100 patients that was presented at the annual meeting of the American Contact Dermatitis Society.

The investigators discovered new allergens for these patients and confirmed others based on patch testing with workplace materials including chemicals, protective equipment, skin care products, and other materials.

Of 113 employees who were custom patch tested at the Occupational Disease Specialty Program at St. Michael's Hospital in Toronto, 24% had a positive reaction to at least one allergen.

Dr. D. Linn Holness and her associates showed that custom testing identified the culprit that caused dermatitis for 12% of patients when standard tests were negative. In addition, a custom approach confirmed a suspected allergen in another 12% of patients.

Custom patch testing, therefore, adds diagnostic value to conventional standard tests, Dr. Holness said.

"Knowing the specific product helps when returning the person to the workplace – knowing they have to avoid one paint coating, for example," said Dr. Holness, chair of the department of occupational and environmental health at the University of Toronto.

The 113 workers were among a total of 753 manufacturing and automotive industry employees who were patch tested in 2002-2009. (The majority received standard allergen screening.) Their mean age was 44 years, and 63% were men. Glues, adhesives, wood dust, foam dust, wood, spices, and workplace skin care products were among the materials evaluated.

Most case reports in the literature use occlusion, but open and semiopen custom patch testing also are reported. There is little consensus in the literature overall regarding the ideal method or methods for performing this testing, however. Dr. Holness noted that "our dermatologists were using a variety of different methods."

Dr. Holness said she was pleased that the custom testing added value to the clinical diagnoses for these workers. "We did this study to support the custom testing," she said. "We got challenged by some of our occupational medicine colleagues claiming our testing methods were not appropriate, were hazardous, and we shouldn't be doing this. They took it to our workman's compensation board."

Dr. Holness said that she had no relevant disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS - The epidemiology of occupational skin disorders may be undergoing substantial change, results of a large new study suggest.

Historically, dermatologic disorders have accounted for 10%-15% of all workplace injuries, and contact dermatitis represented more than 90% of all workers' compensation claims for occupational skin disorders. But results of a new study conducted in a large, multisite occupational medicine program contradict both of these historical findings, Dr. Nita Kohli reported at the annual meeting of the American Academy of Dermatology.

The study included approximately 147,000 patients who were seen at Kaiser Permanente occupational medicine clinics located throughout Southern California during 2004-2008. Skin disorders accounted for just 1% of all workplace injuries, not the 10%-15% previously reported by other investigators. And burns – not contact dermatitis – made up the largest category of dermatologic claims.

Indeed, burns accounted for 65% of all workers' compensation cases involving skin disorders, compared with contact dermatitis (20%), infections (9%), bites (4%), and "unspecified" (2%).

About 90% of occupational dermatologic disorders among food workers were burns. In addition, burns accounted for the majority of skin injuries in all other occupational classes (including office jobs), with the sole exception of personal care jobs, in which burns were slightly outnumbered by cases of dermatitis, according to Dr. Kohli of the University of California, Los Angeles.

The occupational skin disorders caseload consisted of equal numbers of women and men. The average time to the first clinic visit was 12.1 days. Construction and production workers averaged 4.3 clinic visits per claim, compared with transportation workers (3.5), food workers (3.4), cleaning personnel (3.2), and health care workers (2.9).

The hands were the most frequently affected body part.

Burns resulted in an average of 4.3 lost workdays, compared with infections (4.2) and contact dermatitis (2.3). On average, patients lost 3.1 workdays because of their occupational skin disorder. Construction workers missed an average of 8.1 days of work, more than twice as many as did workers in any other occupational category.

The average treatment duration for patients with an occupational skin disorder was 33.5 days; contact dermatitis entailed by far the greatest average treatment length (53 days).

Dr. Kohli declared having no relevant financial disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.

NEW ORLEANS – Suspect an allergic reaction to inactive ingredients in topical corticosteroids when patients do not improve despite usual treatment regimens, a retrospective study suggests.

"An allergy prevalence of 4% for an emulsifier widely used in corticosteroids and personal care products is very important," Brienne Danielle Cressey said at the annual meeting of the American Contact Dermatitis Society.

Ms. Cressey and her associates in the dermatology department at Tufts Medical Center, Boston, reviewed charts of 591 patients who were patch-tested between November 2008 and May 2010. They found that 24 of these patients (4.1%) had positive reactions to a sorbitan emulsifier found in many corticosteroid formulations.

Specifically, 3.9% reacted positively to sorbitan sesquioleate (SSO); 0.85% to sorbitan monooleate (SMO); and 0.7% to both.

"It was thought previously to be an uncommon allergen," said Ms. Cressey, a student at the Maine Medical Center Tufts University School of Medicine (class of 2013) in Portland. In a previous study conducted at Tufts University, researchers found an 8.9% prevalence of sorbitan allergy among 112 dermatitis patients (Dermatitis 2008;19:323-7).

Even though sorbitan allergy was less common in the current study, "we feel it's still an important allergen, with a prevalence greater than 1%." These emulsifiers are not included in the standard patch-testing series, Ms. Cressey said.

Patients were patch-tested using the Tufts Medical Center standard series and a preservative series containing SSO in 20% petrolatum and SMO 5% in petrolatum. Results were read at 48 and 72 hours. The majority were weak reactors: 22 patients were + and 2 were ++. "Our only two patients with 2+ reactions were children with generalized dermatitis," Ms. Cressey said.

Only one patient reacted to any of the four different corticosteroid screening chemicals tested, confirming that these reactions were caused by the sorbitan emulsifiers.

In the positive reaction group, the average duration of contact dermatitis was 43 months, the mean age was 40 years, and 46% were atopic. Dermatitis of the upper extremity and face was the most common.

The sources of sorbitan exposure were personal care products (10 patients), topical corticosteroids (9 patients), and ingestion (5 patients). Ingestion included, for example, sorbitans as a medication ingredient, Ms. Cressey said. "One patient with axillary dermatitis was using deodorant with sorbitol," she added.

The fact that the majority of reactions to SSO were weak raises a question as to whether this emulsifier is a contact or irritant allergen, Ms. Cressey said. Because 27 of 591 patients also were questionable for SSO reactions, "SSO is most likely not an irritant," she said.

In addition to topical corticosteroids, sorbitol-based emulsifiers are found in topical antibiotics, topical antifungals, topical retinoids, and moisturizing creams and lotions (Dermatitis 2008;19:339-41). This publication includes a list of products that commonly contain SSO, sorbitol, and sorbitol derivatives.

Ms. Cressey said that she had no relevant disclosures.

NEW ORLEANS – The use of potent or very potent topical corticosteroids in pregnancy is associated with a significantly increased risk of fetal growth retardation, according to a very large population-based cohort study.

Fortunately, maternal exposure to topical corticosteroids was not associated with any other adverse outcomes, including miscarriage, stillbirth, preterm delivery, or orofacial cleft, Dr. Linda F. Stein said in highlighting the study findings at the annual meeting of the American Academy of Dermatology.

Dr. Stein, director of dermatology research at Henry Ford Hospital in Detroit, singled out the study for special attention because its unusually large size makes for convincingly strong conclusions regarding an issue for which there has been a dearth of data: the safety of topical steroids in pregnancy.

Investigators at Chang Gung University in Taoyuan, Taiwan, and the University of Oxford (England) used the U.K. General Practice Research Database to identify 35,503 women who had been prescribed topical corticosteroids during or shortly before pregnancy, and a control group comprising 48,630 unexposed pregnant women.

Maternal exposure to potent or very potent topical steroids was associated with an adjusted 2.1-fold increased relative risk of fetal growth restriction. Moreover, a significant dose-response relationship was found, such that for every 30 g of prescribed potent or very potent topical steroids, the risk of fetal growth retardation climbed by about 3%. The risk rose with the increasing potency of the topical medication.

The investigators estimated that 168 pregnant women would have to receive potent or very potent topical steroids in order to result in one additional case of fetal growth restriction (J. Invest. Dermatol. 2010 Dec. 30 [doi:10.1038/jid.2010.392]).

Dr. Stein had no relevant financial interests.

NEW ORLEANS – The use of potent or very potent topical corticosteroids in pregnancy is associated with a significantly increased risk of fetal growth retardation, according to a very large population-based cohort study.

Fortunately, maternal exposure to topical corticosteroids was not associated with any other adverse outcomes, including miscarriage, stillbirth, preterm delivery, or orofacial cleft, Dr. Linda F. Stein said in highlighting the study findings at the annual meeting of the American Academy of Dermatology.

Dr. Stein, director of dermatology research at Henry Ford Hospital in Detroit, singled out the study for special attention because its unusually large size makes for convincingly strong conclusions regarding an issue for which there has been a dearth of data: the safety of topical steroids in pregnancy.

Investigators at Chang Gung University in Taoyuan, Taiwan, and the University of Oxford (England) used the U.K. General Practice Research Database to identify 35,503 women who had been prescribed topical corticosteroids during or shortly before pregnancy, and a control group comprising 48,630 unexposed pregnant women.

Maternal exposure to potent or very potent topical steroids was associated with an adjusted 2.1-fold increased relative risk of fetal growth restriction. Moreover, a significant dose-response relationship was found, such that for every 30 g of prescribed potent or very potent topical steroids, the risk of fetal growth retardation climbed by about 3%. The risk rose with the increasing potency of the topical medication.

The investigators estimated that 168 pregnant women would have to receive potent or very potent topical steroids in order to result in one additional case of fetal growth restriction (J. Invest. Dermatol. 2010 Dec. 30 [doi:10.1038/jid.2010.392]).

Dr. Stein had no relevant financial interests.

NEW ORLEANS – The use of potent or very potent topical corticosteroids in pregnancy is associated with a significantly increased risk of fetal growth retardation, according to a very large population-based cohort study.

Fortunately, maternal exposure to topical corticosteroids was not associated with any other adverse outcomes, including miscarriage, stillbirth, preterm delivery, or orofacial cleft, Dr. Linda F. Stein said in highlighting the study findings at the annual meeting of the American Academy of Dermatology.

Dr. Stein, director of dermatology research at Henry Ford Hospital in Detroit, singled out the study for special attention because its unusually large size makes for convincingly strong conclusions regarding an issue for which there has been a dearth of data: the safety of topical steroids in pregnancy.

Investigators at Chang Gung University in Taoyuan, Taiwan, and the University of Oxford (England) used the U.K. General Practice Research Database to identify 35,503 women who had been prescribed topical corticosteroids during or shortly before pregnancy, and a control group comprising 48,630 unexposed pregnant women.

Maternal exposure to potent or very potent topical steroids was associated with an adjusted 2.1-fold increased relative risk of fetal growth restriction. Moreover, a significant dose-response relationship was found, such that for every 30 g of prescribed potent or very potent topical steroids, the risk of fetal growth retardation climbed by about 3%. The risk rose with the increasing potency of the topical medication.

The investigators estimated that 168 pregnant women would have to receive potent or very potent topical steroids in order to result in one additional case of fetal growth restriction (J. Invest. Dermatol. 2010 Dec. 30 [doi:10.1038/jid.2010.392]).

Dr. Stein had no relevant financial interests.

KEYSTONE, COLO. - Lack of the keratin-binding protein filaggrin in the skin's epidermis contributes to immune dysregulations that serve to retard defenses against allergens and microbes such as Staphylococcus aureus, helping pave the way for atopic dermatitis and, possibly, a lifetime of allergies.

Learning how those allergens work in concert with an inflammatory cytokine called thymic stromal lymphopoietin (TSLP) may illuminate a key link between filaggrin deficiency and a "Th2-type milieu," thus helping researchers develop an agent that could prevent atopy, Dr. Donald Y. M. Leung reported at a meeting on allergy and respiratory diseases.

Such an agent would be a welcome addition to current options for the management or prevention of atopic dermatitis (AD), which has a higher prevalence in young children than do food allergies, asthma, and allergic rhinitis.

"Atopic dermatitis is one of the few diseases where we can actually see what's going on, using biopsy or noninvasive techniques, to actually sample which of the proteins are changing and then intervene, I think, in a very scientific way," said Dr. Leung, head of the division of pediatric allergy and clinical immunology at National Jewish Health in Denver and editor-in-chief of the Journal of Allergy and Clinical Immunology.

Because AD is strongly associated with food allergies, some of which progress to asthma, preventing the disease could serve a much larger purpose. Research has shown that breakdown of skin barrier defenses opens the door not only to S. aureus, but also to the herpes simplex virus. The role of filaggrin and lipid deficiency in the negation of barrier mechanisms at the skin's mechanical, chemical, and cellular layers – which in turn may spur the advance of AD to a more persistent level of eczema or to asthma – also has been well studied. And filaggrin-deficient mice have demonstrated high levels of systemic atopic sensitization (J. Allergy Clin. Immunol. 2009;124:485-93).

But even though a lack of filaggrin has been associated with increased microbial invasion, the fact that some patients with filaggrin mutations do not develop AD and others outgrow their AD suggests that other factors are at play in progression of the disease, Dr. Leung said at the meeting, sponsored by National Jewish Health.

Less well understood is TSLP's relative contribution to inflammation and the processes that lead to the atopic march. The responsibility TSLP shares with other causal factors, such as infection, allergen exposure, and the barrier-damaging effects of the AD itch-scratch cycle, have not been well quantified. What researchers do know is that TSLP is commonly found in atopic skin, the gut of food allergy patients, and the lungs of asthmatics.

Dr. Leung calls it the "cytokine of the moment."

"T cells are educated in the milieu of the skin," he explained. "The skin is probably the most highly IgE-inducing organ in the body. There are multiple cytokines, like TSLP and IL-4, which can be released from mast cells, that augment the Th2 response. If one made a systemic anti-TSLP, in theory, and if we knew when to use it, it could reverse atopy."

Researchers are still working to characterize the timing of TSLP production by keratinocytes. Another riddle is just when during the course of a progressing atopic disease any anti-TSLP product should be introduced.

"Because people who come to us often have established disease, we may need to be intervening so early in the disease that we will not get there until we have the right biomarkers," Dr. Leung said.

Dr. Leung reported having no significant disclosures.

KEYSTONE, COLO. - Lack of the keratin-binding protein filaggrin in the skin's epidermis contributes to immune dysregulations that serve to retard defenses against allergens and microbes such as Staphylococcus aureus, helping pave the way for atopic dermatitis and, possibly, a lifetime of allergies.

Learning how those allergens work in concert with an inflammatory cytokine called thymic stromal lymphopoietin (TSLP) may illuminate a key link between filaggrin deficiency and a "Th2-type milieu," thus helping researchers develop an agent that could prevent atopy, Dr. Donald Y. M. Leung reported at a meeting on allergy and respiratory diseases.

Such an agent would be a welcome addition to current options for the management or prevention of atopic dermatitis (AD), which has a higher prevalence in young children than do food allergies, asthma, and allergic rhinitis.

"Atopic dermatitis is one of the few diseases where we can actually see what's going on, using biopsy or noninvasive techniques, to actually sample which of the proteins are changing and then intervene, I think, in a very scientific way," said Dr. Leung, head of the division of pediatric allergy and clinical immunology at National Jewish Health in Denver and editor-in-chief of the Journal of Allergy and Clinical Immunology.

Because AD is strongly associated with food allergies, some of which progress to asthma, preventing the disease could serve a much larger purpose. Research has shown that breakdown of skin barrier defenses opens the door not only to S. aureus, but also to the herpes simplex virus. The role of filaggrin and lipid deficiency in the negation of barrier mechanisms at the skin's mechanical, chemical, and cellular layers – which in turn may spur the advance of AD to a more persistent level of eczema or to asthma – also has been well studied. And filaggrin-deficient mice have demonstrated high levels of systemic atopic sensitization (J. Allergy Clin. Immunol. 2009;124:485-93).

But even though a lack of filaggrin has been associated with increased microbial invasion, the fact that some patients with filaggrin mutations do not develop AD and others outgrow their AD suggests that other factors are at play in progression of the disease, Dr. Leung said at the meeting, sponsored by National Jewish Health.

Less well understood is TSLP's relative contribution to inflammation and the processes that lead to the atopic march. The responsibility TSLP shares with other causal factors, such as infection, allergen exposure, and the barrier-damaging effects of the AD itch-scratch cycle, have not been well quantified. What researchers do know is that TSLP is commonly found in atopic skin, the gut of food allergy patients, and the lungs of asthmatics.

Dr. Leung calls it the "cytokine of the moment."

"T cells are educated in the milieu of the skin," he explained. "The skin is probably the most highly IgE-inducing organ in the body. There are multiple cytokines, like TSLP and IL-4, which can be released from mast cells, that augment the Th2 response. If one made a systemic anti-TSLP, in theory, and if we knew when to use it, it could reverse atopy."

Researchers are still working to characterize the timing of TSLP production by keratinocytes. Another riddle is just when during the course of a progressing atopic disease any anti-TSLP product should be introduced.

"Because people who come to us often have established disease, we may need to be intervening so early in the disease that we will not get there until we have the right biomarkers," Dr. Leung said.

Dr. Leung reported having no significant disclosures.

KEYSTONE, COLO. - Lack of the keratin-binding protein filaggrin in the skin's epidermis contributes to immune dysregulations that serve to retard defenses against allergens and microbes such as Staphylococcus aureus, helping pave the way for atopic dermatitis and, possibly, a lifetime of allergies.

Learning how those allergens work in concert with an inflammatory cytokine called thymic stromal lymphopoietin (TSLP) may illuminate a key link between filaggrin deficiency and a "Th2-type milieu," thus helping researchers develop an agent that could prevent atopy, Dr. Donald Y. M. Leung reported at a meeting on allergy and respiratory diseases.

Such an agent would be a welcome addition to current options for the management or prevention of atopic dermatitis (AD), which has a higher prevalence in young children than do food allergies, asthma, and allergic rhinitis.

"Atopic dermatitis is one of the few diseases where we can actually see what's going on, using biopsy or noninvasive techniques, to actually sample which of the proteins are changing and then intervene, I think, in a very scientific way," said Dr. Leung, head of the division of pediatric allergy and clinical immunology at National Jewish Health in Denver and editor-in-chief of the Journal of Allergy and Clinical Immunology.

Because AD is strongly associated with food allergies, some of which progress to asthma, preventing the disease could serve a much larger purpose. Research has shown that breakdown of skin barrier defenses opens the door not only to S. aureus, but also to the herpes simplex virus. The role of filaggrin and lipid deficiency in the negation of barrier mechanisms at the skin's mechanical, chemical, and cellular layers – which in turn may spur the advance of AD to a more persistent level of eczema or to asthma – also has been well studied. And filaggrin-deficient mice have demonstrated high levels of systemic atopic sensitization (J. Allergy Clin. Immunol. 2009;124:485-93).

But even though a lack of filaggrin has been associated with increased microbial invasion, the fact that some patients with filaggrin mutations do not develop AD and others outgrow their AD suggests that other factors are at play in progression of the disease, Dr. Leung said at the meeting, sponsored by National Jewish Health.

Less well understood is TSLP's relative contribution to inflammation and the processes that lead to the atopic march. The responsibility TSLP shares with other causal factors, such as infection, allergen exposure, and the barrier-damaging effects of the AD itch-scratch cycle, have not been well quantified. What researchers do know is that TSLP is commonly found in atopic skin, the gut of food allergy patients, and the lungs of asthmatics.

Dr. Leung calls it the "cytokine of the moment."

"T cells are educated in the milieu of the skin," he explained. "The skin is probably the most highly IgE-inducing organ in the body. There are multiple cytokines, like TSLP and IL-4, which can be released from mast cells, that augment the Th2 response. If one made a systemic anti-TSLP, in theory, and if we knew when to use it, it could reverse atopy."

Researchers are still working to characterize the timing of TSLP production by keratinocytes. Another riddle is just when during the course of a progressing atopic disease any anti-TSLP product should be introduced.

"Because people who come to us often have established disease, we may need to be intervening so early in the disease that we will not get there until we have the right biomarkers," Dr. Leung said.

Dr. Leung reported having no significant disclosures.