Biomedical subjects
Publications and source records attributed to Erin Warshaw.
Allergic contact dermatitis is a common skin condition that can be difficult to diagnose without the aid of a specific diagnostic tool called patch testing. The pathophysiology, clinical features, diagnosis, and treatment of allergic contact dermatitis are summarized in this review. The process of patch testing, the gold standard for diagnosing allergic contact dermatitis, is discussed in detail.
During the 1990s, contact allergy to topical corticosteroids became a well-recognized complication of dermatologic therapy. Groups of related corticosteroids were subsequently identified on the basis of their chemical structures, and some investigators have found these helpful in identifying potential cross-reactions. The widespread use of hydrocortisone as an over-the-counter medication and its addition to a wide array of topical products make hydrocortisone the most common allergen. Awareness of the risk of corticosteroid allergy and the availability of newer topical immunomodulating agents such as tacrolimus and pimecrolimus may eventually reduce the incidence of contact allergy to corticosteroids. Rokea el-Azhary, MD, PhD, Professor of Dermatology at the Mayo Clinic in Rochester, MN; Erin Warshaw, MD, Associate Professor of Dermatology at the University of Minnesota, Veterans Affairs Medical Center; and Kalman L. Watsky, MD, Associate Clinical Professor, Department of Dermatology, Yale University School of Medicine, and Section Chief of Dermatology, Hospital of Saint Raphael, were invited to give their opinions on strategies for detecting allergens and recommending allergen substitution for patients with suspected topical corticosteroid allergy.
OBJECTIVE: The primary objective of this double-blind randomized, pilot study was to evaluate whether previously prepared stored patches may be as effective as freshly prepared patches are for detecting contact allergy. METHODS: Two sets of 62 nonaqueous allergens were applied to participants' upper backs. One set was freshly prepared, and the second set was previously prepared and stored for an average of 6 weeks. Right or left back location for each set was randomly assigned. The primary outcome assessment compared the proportions of fresh and strong reactions in pairs with complete discordance (negative on one side and 1+, 2+, or 3+ on the other side). RESULTS: In 71 patients enrolled, there were 169 positive reactions. Concordance (any combination of a 1+, 2+, or 3+ reaction on both sides) was found in 63% of pairs (95% CI: 55.4, 70.0). Of the 25 pairs with complete discordance, there was no statistically significant difference between the rate of positive reactions for fresh and stored patches. CONCLUSION: Pilot evidence suggests that stored patches may be effective in detecting the majority of allergic contact reactions. Larger studies are needed to evaluate antigen-specific effects as well as effects of varying lengths of antigen storage.
Hand dermatitis is a common skin condition that may be chronic, debilitating, and costly for patients, insurers, and employers. The epidemiology, clinical features, occupational issues, and long-term outcomes of hand dermatitis are summarized in this review. Therapeutic options are also discussed in detail, focusing on treatment of recalcitrant hand dermatitis.
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An 85-year-old male with glaucoma presented with a 1-1/2 year history of tearing; red eyes; and pruritic, edematous, eczematous eyelids. Treatment for presumed ocular rosacea and seborrhea was unhelpful. Patch testing to our standard 64 antigens yielded a positive reaction to Balsam of Peru. Notably, benzalkonium chloride, thimerosal, and other preservatives elicited negative reactions. Repeat open application testing elicited positive results to Xalatan (latanoprost) 0.005% ophthalmic solution (Pharmacia & Upjohn, Kalamazoo, MI). A second session of patch tests to 10 personal products, in addition to Xalatan 0.005% solution and the Xalatan vehicle (provided by the manufacturer), elicited a strong positive reaction only to the full preparation of Xalatan 0.005% solution. This report describes the first known case of ACD to latanoprost, a new prostaglandin analog that is widely prescribed for treatment of glaucoma.
Perineal dermatitis due to urinary and/or fecal incontinence is a common problem. A multicenter, open label, phase II product evaluation was conducted to determine the effectiveness of a new cleanser protectant lotion in reducing perineal erythema and pain in patients at low-risk for perineal dermatitis and to compare the cost of this product to standard protocols of care. Nineteen elderly patients (14 male, 5 female, mean age 73.1 years) participated in the study. Average baseline scores for erythema and pain were 2.3 (+/- 0.5) and 1.5 (+/- 1.0), respectively (scale 0 to 4). After 7 days, both scores were significantly lower (mean scores 0.6 +/- 0.8 and 0.3 +/- 0.8, respectively; P < 0.01). Based on an average of 2.6 perineal episodes per day, the one-step product evaluated would cost $136 per patient/year less than standard protocols of care while reducing caregiver time (average 23 seconds per episode of care). Optimal perineal care may reduce the incidence of complications; studies to ascertain the safety and effectiveness of commonly used products and procedures are needed.