A Robust Case of Allergic Contact Dermatitis to Propolis

Allergic contact dermatitis (ACD) occurs when an individual comes into cutaneous contact with a substance to which he or she has been sensitized to, causing a delayed-type hypersensitivity reaction. While the diagnosis may in some cases be easily suspected due to a classic history and exam, not all cases are obvious. Patch testing is an extremely useful process that allows for the diagnosis of ACD to be made while also identifying the specific chemical trigger. Present in beeswax and composed of a mixture of resins, waxes, oils, pollen, and various organic compounds, propolis is a well-known cause of ACD. Here we present the case of ACD to propolis in an unusual product and with impressive clinical findings. A 58 year-old woman of Native American descent with a history of Sjogren\u27s syndrome presented to Dermatology for a one year history of a painful and pruritic rash on her lips and face. She had temporary improvement with a previous course of prednisone followed by relapse upon tapering, but otherwise the rash had been worsening despite the use of high-potency topical steroids. She was also using bear grease and lip butter as moisturizers. On physical exam she had a well-demarcated symmetric perioral erythematous lichenified scaly plaque, as well as confluent erythema and scaling of her mucosal lips. After tinea incognito was ruled out by fungal culture, she subsequently underwent patch testing for suspected ACD. The diagnosis was confirmed with positive reactions at both the 2 day and 7 day reads to propolis and her bear grease and lip butter, both of which contained beeswax. The patient had complete resolution shortly after discontinuation of these products, and she was advised to avoid other products that contain propolis. With a soft and pliable texture and pleasant aroma, propolis is present in many creams, ointments, waxes, lipsticks, and balms. Moreover, with it\u27s reported anti-inflammatory and antimicrobial properties, it can also be found in various cosmeceutical, naturopathic, and homeopathic products. Made from bear fat and beeswax, the bear grease product the patient was using was advertised as having natural healing benefits and was purchased at a Native American craft store. This case is unique, as it represents a common allergen found in an uncommon vehicle. Moreover, it illustrates the importance of taking a comprehensive history when assessing for ACD, as well as the utility of patch testing.https://scholarlycommons.henryford.com/merf2020caserpt/1111/thumbnail.jp

Delayed phase of Hematoporphyrin-Induced Phototoxicity: Modulation by Complement, Leukocytes, and Antihistamines

We have investigated the role of complement, leukocytes, and histamine in the delayed phase of hematoporphyrin-induced phototoxicity in guinea pigs. The phototoxic response was quantified by the accumulation of intravenously injected [125I]bovine serum albumin in the skin. There was a greater than 6-fold increase in the vascular response at the completion of irradiation, which subsided partially to reach a plateau of twice the preirradiation level between 0.5 h and 12 h. At 18 h the vascular responsiveness returned to the baseline value. The 7 h timepoint was selected in this study to evaluate the modulation of the delayed phase. In complement-depleted guinea pigs, as well as in leukopenic animals, the enhancement in the vascular response was significantly suppressed (p vs control, < 0.0001 and 0.0022. respectively). Cimetidine, when administered prior to irradiation, significantly suppressed the phototoxic response (p vs control, 0.0365). The combination of diphenhydramine and cimetidine, administered 6 h after the induction of phototoxicity, also suppressed the vascular response (p vs control, < 0.0001). These data indicate that the expression of the delayed phase of hematoporphyrin-iuduced phototoxicity, similar to the early phase, requires the presence of an intact complement system, leukocytes, and histamine

32131 Updating the relative risk of ultraviolet exposure and melanoma in fair skin types: A systematic review

In 2005, a meta-analysis found that varying types of UV exposure contributed to an increased relative risk of melanoma. Recently, a 2021 review failed to establish a similar link in individuals with skin of color. Within the last 2 decades, no studies have comprehensively reviewed the risk of varying types of UV exposure on melanoma in fair skin. Thus, we performed a systematic review from 2002-2021 analyzing UV exposure and melanoma risk in Fitzpatrick type I-IV individuals. Out of 12,263 studies, 26 met inclusion criteria. A majority showed an association with UV index (6/9), left-sided laterality (1/1), sunburn history (11/13), and outdoor leisure activity (3/3). UV index studies were all ecological and presented primarily positive correlations. For sunburn history, studies encompassed 2309 melanomas, and significant odds ratios (OR) ranged from 1.69 (1.00-2.98) to 8.48 (4.35-16.54) with higher odds ratios for increasing numbers of sunburns. For outdoor leisure correlating with prior definitions of intermittent sun exposure, studies encompassed 514 melanomas, and ORs ranged from 2.70 (1.04-6.80) to 4.18 (1.83-9.93). A positive association was found in 2 (n = 2/6) studies for cumulative or annual sun exposure, 2 (n = 2/5) studies with occupational sun exposure, 2 (n = 2/4) studies with sun vacations, and 0 (n = 0/2) studies with latitude. This study highlights the significant relationships between specific types of UV exposure and melanoma at higher rates than previously summarized due to an emphasis on fair skin types. Critically, there remains high heterogeneity in how UV exposure is captured that may contribute to mixed results

Congenital erythropoietic porphyria associated with myelodysplasia presenting in a 72-year-old man: report of a case and review of the literature

Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disease owing to the deficient activity of uroporphyrinogen III synthase, the fourth enzyme in the porphyrin–haem synthetic pathway. Of the porphyrias, it is the most mutilating type, usually presenting early in life. To date, 12 documented cases of adult onset CEP have been reported. We report the second oldest documented patient with late onset CEP with incidental findings of thrombocytopenia and myelodysplasia with bone-marrow sideroblasts. We further discuss several current and future treatment options for this therapeutically challenging disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73760/1/j.1365-2133.2003.05040.x.pd

Demographics and clinical presentations of 844 patients with light and dark skin types with polymorphous light eruption and chronic actinic dermatitis evaluated over 23 years

INTRODUCTION: Polymorphous light eruption (PMLE) and chronic actinic dermatitis (CAD) have been classically described in White individuals, although recent studies have reported higher prevalence in patients with dark skin types, particularly African Americans. OBJECTIVE: To evaluate for differences in demographic, and clinical features between persons with light and dark skin types who have PMLE and CAD. METHODS: Retrospective review of patients with PMLE and CAD who were diagnosed from January 1, 1998, through November 31, 2021, at a single academic dermatology center. RESULTS/DISCUSSION: A total of 844 patients (725 [85.9%] female; mean [SD] age of onset: 41.7 [16.9] years) were diagnosed with PMLE, and 60 patients (22 [36.6%] female; mean age, [SD]: 60.6 [10.6] years) of age at presentation, disease duration of 8.2 [7.3] years were diagnosed with CAD. Although just over 50% of the general clinic population was White, the prevalence of PMLE and CAD was significantly higher in dark-skinned individuals compared to light-skinned individuals (PMLE: 625 [74.0%] vs. 219 [25.9%], p value \u3c .001; CAD: 43 [71.6%] vs. 17 [28.3%], p value = .003) respectively. The pinpoint papular variant of PMLE (PP-PMLE) was predominantly seen in dark-skinned individuals. CONCLUSION: A substantial proportion of PMLE and CAD cases are present in dark-skinned individuals. PP-PMLE can be mistaken for lichen nitidus. As such, recognition of this entity is important for adequate evaluation and management of patients with PMLE

28522 The impact of the SARS-CoV-2 pandemic on phototherapy utilization

Phototherapy is a mainstay of treatment for several dermatologic conditions. Patients often require multiple treatments per week for several weeks to months to achieve treatment efficacy. The SARS-CoV-2 global pandemic caused many dermatology clinics to close completely or significantly reduce patient volumes, which may have limited patient access to this beneficial treatment. This retrospective study examines the pandemic’s impact on phototherapy treatment rates and reimbursement at one major tertiary care center and five locations of a private dermatology clinic in Southeast Michigan. Phototherapy CPT reimbursement data from March 1-June 30, 2020 was compared with the same timeframe in 2019. Units of phototherapy performed decreased by an average of 84%, and there was an average decrease of 43% in the number of unique patients receiving treatments. Reimbursement for phototherapy decreased by an average of 83%. The drastic decline in phototherapy reimbursement is a reflection of the pandemic’s financial impact and likely correlates to a larger scale of revenue loss in dermatology practices. Adequate phototherapy treatment was also likely delayed for many patients. As the pandemic continues, implementation of home phototherapy treatments may be necessary for patients to receive proper treatment and to minimize the impact of loss of revenue due to limited in-office phototherapy. Precautions will need to be taken to guarantee the safety of patients and the care team for patients to receive optimal in-office phototherapy treatment. The pandemic’s impact on medical dermatology finances could potentially destabilize access to patients who need this safe and effective treatment