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Background: Topical corticosteroid phobia (TOPICOP) is associated with poor treatment adherence and is common among patients with skin disease. Knowledge about corticosteroid phobia and treatment adherence among patients with chronic hand eczema (CHE) is limited., Objectives: To investigate patient-reported outcomes regarding topical corticosteroids (TCSs), and their impact on treatment adherence in patients with CHE., Methods: Patients with CHE from the Danish Skin Cohort answered a questionnaire including the TOPICOP scale and Medication Adherence Report Scale. Response rate was 69.2%., Results: Of 927 with CHE, 75.5% totally or almost agreed that TCS damage the skin, 48.9% totally or almost agreed that TCS would affect their future health and 36.3% reported some degree of fear of TCS although they were unaware of any TCS-associated risks. Most patients (77.9%) always or often stop treatment as soon as possible, whereas 54.8% always or often wait as long as possible before starting treatment. Overall, 38.8% reported that they had taken less medicine than prescribed and 54.0% had stopped treatment throughout a period. Treatment adherence decreased with increasing corticosteroid phobia (P = .004)., Limitations: TOPICOP has not been validated in patients with CHE., Conclusions: Corticosteroid phobia is common among patients with CHE and negatively associated with treatment adherence., Competing Interests: Conflicts of interest Dr Christensen has been a subinvestigator for LEO Pharma, with no relation to this manuscript. Dr Guttman-Yassky is an employee of Mount Sinai, has received research grants from Boehringer Ingelheim, LEO Pharma, Pfizer, Cara Therapeutics, UCB, Kyowa Kirin, RAPT, Amgen, GSK, Incyte, Sanofi, Bristol Meyers Squibb, Aslan, Regeneron, AnaptysBio, Concert, and Janssen, and is a consultant for AbbVie, Almirall, Amgen, AnaptysBio, Apogee Therapeutics, Apollo Therapeutics Limited, Artax Biopharma Inc, AstraZeneca, Bristol Meyers Squibb, Boehringer Ingelheim, Cara Therapeutics, Centrexion Therapeutics Corporation, Connect Biopharm, Eli Lilly, Enveda Biosciences, Escient Pharmaceuticals, Inc, Fairmount Funds Management LLC, FL2022-001, Inc, Galderma, Gate Bio, Google Ventures (GV), GSK Immunology, Horizon Therapeutics USA, Inc, Incyte, Inmagene, Janssen Biotech, Japan Tobacco, Jasper Therapeutics, Kyowa Kirin, LEO Pharma, Merck, Nektar Therapeutics, Novartis Pharmaceuticals Corporation, NUMAB Therapeutics AG, OrbiMed Advisors LLC, OTSUKA Pfizer, Pharmaxis Ltd, Pioneering Medicine VII, Inc, Proteologix US Inc, RAPT, Regeneron Pharmaceuticals, Ribon Therapeutics, Inc, Sanofi, SATO, Schrödinger, Inc, Sun Pharma Advanced Research Company (SPARC), Teva Branded Pharmaceutical Products R&D, Inc, and UCB, with no relation to this manuscript. Dr Ezzedine has been a consultant and speaker and has received funding from AbbVie, Incyte, Lilly, Pfizer, Pierre Fabre, L’Oreal, BMS, and MSD, with no relation to this manuscript. Dr Schlapbach has received honoraria as adviser or speaker for AbbVie, Almirall, BMS, Incyte, LEO Pharma, Lilly, Kiowa Kirin, Novartis, Pfizer, and Sanofi and has received research funding from PPM Services, with no relation to this manuscript. Dr Molin has received honoraria as consultant/adviser or speaker and/or grants from AbbVie, Almirall, Aralez, Arcutis, Basilea, Bausch and Lomb, Bristol Myer Squibb, Boehringer Ingelheim, Evidera, Galderma, GSK, Incyte, LEO Pharma, Lilly, Novartis, Pfizer, Sanofi, Sun Pharma, and UCB, and is currently investigator for Novartis and LEO Pharma, with no relation to this manuscript. Dr Zhang has served on advisory boards and receives honorarium for Pfizer Investment Co, Ltd, Novartis Pharmaceuticals (China), Sanofi China, LEO Pharma (Shanghai) Co, Ltd, GSK (China) Investment Co, Ltd, Eli Lilly and Company (China), Xi’an Janssen Pharmaceutical Ltd, Bristol-Myers Squibb (China) Investment Co, Ltd, Beijing Wenfeng Tianji Pharma Ltd, Keymed Biosciences (Chengdu) Ltd, Akeso Biopharma Co, Ltd, Reistone Biopharma Co, Ltd, and Kintor Pharmaceutical Ltd, with no relation to this manuscript. Dr Zachariae has been a paid speaker for Eli Lilly, Novartis, CSL, and LEO Pharma, and has been a consultant or has served on advisory boards with AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, Takeda, Amgen, and CSL, with no relation to this manuscript. Dr Thomsen has been a speaker or has served on advisory boards for Sanofi, AbbVie, LEO Pharma, Pfizer, Eli Lilly, Novartis, UCB Pharma, Union Therapeutics, Almirall, and Janssen Pharmaceuticals, and has received research support from Sanofi, AbbVie, LEO Pharma, Novartis, UCB Pharma, and Janssen Pharmaceuticals, with no relation to this manuscript. Dr Thyssen is an adviser for AbbVie, Almirall, Arena Pharmaceuticals, Coloplast, OM Pharma, Aslan Pharmaceuticals, Union Therapeutics, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron, and Sanofi-Genzyme, has a speaker for AbbVie, Almirall, Eli Lilly & Co, LEO Pharma, Pfizer, Regeneron, and Sanofi-Genzyme, received research grants from Pfizer, Regeneron, and Sanofi-Genzyme, and is a full time employee at LEO Pharma. Dr Egeberg has received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, Boehringer Ingelheim, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, has received honoraria as consultant and/or speaker from Amgen, AbbVie, Almirall, LEO Pharma, Zuellig Pharma Ltd, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co, Ltd, Pfizer, Eli Lilly and Company, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, McNeil Consumer Healthcare, Horizon Therapeutics, Boehringer Ingelheim, and Janssen Pharmaceuticals, and is currently employed by LEO Pharma, with no relation to this manuscript. Authors Sieborg and Nymand have no conflicts of interest to declare., (Copyright © 2024 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Hand eczema (HE) is a heterogeneous and burdensome disorder., Objective: To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing., Methods: Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113)., Results: Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ 2 , P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators., Limitations: No data on HE phenotype., Conclusion: HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2020 American Academy of Dermatology, Inc. All rights reserved.)

Background: Preservatives are often necessary components of commercial products. Large-scale North American studies on preservative allergy are limited., Objective: To evaluate demographics, positive patch test reactions (PPTRs), clinical relevance, and trends for preservatives tested by the North American Contact Dermatitis Group., Methods: We conducted a retrospective cross-sectional analysis of North American Contact Dermatitis Group patch testing results of preservatives from 1994 through 2016., Results: A total of 50,799 patients were tested; 11,338 (22.3%) had a PPTR to at least 1 preservative. The most frequent reactions were to methylisothiazolinone 0.2% aqueous (aq) (12.2%), formaldehyde 2% aq (7.8%), formaldehyde 1% aq (7.8%), quaternium-15 2% petrolatum (pet) (7.7%), and methyldibromo glutaronitrile/phenoxyethanol 2% pet (5.1%). Paraben mix 12% pet (1%), iodopropynyl butylcarbamate 0.1% pet (0.4%), benzyl alcohol 1% pet (0.3%), and phenoxyethanol 1% pet (0.2%) had the lowest PPTRs. Linear regression analysis of preservatives tested showed that only methylchloroisothiazolinone/methylisothiazolinone 0.01% aq (parameter estimate, 0.42; 95% CI, 0.17-0.66; P < .005) had a significant increase in PPTRs over time., Limitations: Collected variables are dependent on clinical judgment. Results may be prone to referral selection bias., Conclusions: This large North American study provides insight on preservative PPTRs and trends from 1994 through 2016., (Copyright © 2020 American Academy of Dermatology, Inc. All rights reserved.)

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily life, and impair social interactions. In this continuing medical education series we review the epidemiology, risk factors, and clinical presentation of onychomycosis and demonstrate current and emerging diagnostic strategies., (Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Symmetrical acrokeratoderma seems to be a new disorder in China, and 138 cases have been reported in the Chinese literature., Objective: We sought to summarize the clinicopathologic features and immunophenotyping of inflammatory cells in 34 new cases., Methods: Clinical data of 34 patients were prospectively collected over 4 years. Histopathology and immunostaining of infiltrated cells were performed in 27 and 9 patients, respectively., Results: Brown to black hyperkeratotic patches were symmetrically distributed over the acral regions in 33 cases and on the scalp in 1 case, with a whitish change after water contact or sweating. The condition was aggravated in summer and alleviated in winter in 33 patients. History of ichthyosis vulgaris was seen in 23 cases. The typical histopathology included epidermal hyperkeratosis, acanthosis, and papillary dermal perivascular infiltrate of lymphohistiocytes. Number of CD3(+), CD4(+), and CD8(+) cells increased in lesional and perilesional skin compared with normal-appearing skin. The skin lesions developed slowly but were confined to the acral predilection sites after the mean follow-up of 25.4 ± 13.8 months., Limitations: The follow-up time was short., Conclusion: This disorder may represent a peculiar dermatosis that is frequently associated with ichthyosis vulgaris. No specific therapy is available for the disorder., (Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Pseudomonas aeruginosa is a ubiquitous gram-negative rod that can cause a well-recognized, acquired skin infection from bacterial colonization of contaminated water called "hot tub folliculitis." We report an outbreak of pseudomonas skin infection associated with the use of a hot tub at a pool party in 33 children. In particular, 2 of the children were admitted to our hospital; both presented with high leukocyte counts, intermittent low grade fevers, and painful, erythematous nodules and papules on their palms and soles. One of the 2 children also presented with small erythematous pustular lesions on the face and trunk, which led to the diagnosis. Cultures from these pustules grew P aeruginosa. Thirty two other children at this pool/hot tub party developed similar lesions of varying severity 6 to 48 hours after the party. These findings were most consistent with the diagnosis of pseudomonas folliculitis/hot hand.

Background: Hand dermatitis, including irritant and allergic contact dermatitis (ACD), is common., Objective: To evaluate allergens, relevant irritants, sources and occupations associated with hand contact dermatitis using North American Contact Dermatitis Group (NACDG) data., Methods: A cross-sectional analysis of 22,025 patients patch tested between 1994 and 2004., Results: Hand involvement was found in 6953 patients; 959 had ACD as the only diagnosis. In these 959 patients, the 12 most frequent relevant allergens were quaternium-15 (16.5%), formaldehyde (13.0%), nickel sulfate (12.2%), fragrance mix (11.3%), thiuram mix (10.2%), balsam of Peru (9.6%), carba mix (7.8%), neomycin sulfate (7.7%), bacitracin (7.4%), methyldibromoglutaronitrile/phenoxyethanol 2.0% (7.4%), cobalt chloride (6.5%), and methyldibromoglutaronitrile/phenoxyethanol 2.5% (6.3%). Rubber allergens were most commonly associated with occupation. One third of patients with hand ACD had identifiable relevant irritants., Limitations: Cross-sectional analyses prevent evaluation of causal associations., Conclusion: In NACDG patients with hand ACD, the most common allergens included preservatives, metals, fragrances, topical antibiotics, and rubber additives.

Background: Scytalidium dimidiatum and S hyalinum are molds responsible for human skin and nail infections in tropical areas., Objective: We sought to examine the epidemiology of cutaneous infections caused by Scytalidium species in a temperate country., Methods: We conducted a retrospective study of patients with Scytalidium spp. infection diagnosed in our laboratory in Paris, France, from 1994 to 1999., Results: Cutaneous Scytalidium infections were diagnosed in 332 patients, all of whom were from the tropics, especially the West Indies and Africa. S hyalinum and S dimidiatum were isolated in 53.6% and 43.9% of cases, respectively, and were associated with dermatophytes in 30 patients. Skin and nail lesions were found in, respectively, 65.3% and 34.7% of cases, and the feet were involved in 90.6% of cases., Conclusion: Cutaneous infections caused by Scytalidium species are far from rare in France, a temperate country, and must not be mistaken for dermatophytosis, given the resistance of S hyalinum and S dimidiatum to most antifungal drugs. Mycologic examination is, thus, required to identify Scytalidium spp in patients returning from or residing in tropical areas.

Background: Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of onychomycosis in North America., Objective: A 12-center study was undertaken to (1) determine the frequency of onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates., Methods: A total of 1832 subjects participated in this study and completed a comprehensive questionnaire, and nail clippings were collected for potassium hydroxide examination and culturing., Results: The frequency of onychomycosis, as defined by the presence of septate hyphae on direct microscopy and/or the recovery of a dermatophyte, was found to be 13.8%. In general, the dermatophyte isolates were susceptible to the antifungals tested., Conclusion: Because of the limited number of large-scale studies, the baseline incidence is not firmly established. However, the higher frequency of onychomycosis in this study may confirm the suspected increase in incidence of disease in North America.

Background: Onychomycosis is a widespread refractory disease deleteriously affecting quality of life via social stigma and disrupting daily activities. Many physicians perceive onychomycosis as a cosmetic rather than a medical problem., Objective: Our purpose was to develop a questionnaire-based instrument to quantify the impact of onychomycosis on patients' quality of life., Methods: The questionnaire was developed and validated in a multinational cross-sectional study. Completed questionnaires from 532 patients were analyzed: 284 toenail, 248 fingernail (onychomycosis or paronychia)., Results: The degree of quality of life impairment from onychomycosis varied by country studied, possibly reflecting cross-national health perception differences. Longer duration of disease, greater involvement of individual nails, and greater number of nails involved were associated with more serious adverse effects. Many physicians underestimated the associated degree of pain., Conclusion: The study confirms that onychomycosis physically and psychologically affects patients' lives. The questionnaire may be a valuable tool in evaluating the effect of therapeutic agents on quality of life of patients with onychomycosis.

Background: In our routinely patch tested patients with dermatitis gold was shown to be the second most common sensitizer. In most patients it was difficult to explain the source of sensitization to gold and to see any clinical relevance., Objective: Our purpose was to elucidate the clinical relevance of contact allergy to gold sodium thiosulfate., Methods: A questionnaire on gold exposure and gold sensitivity was answered by 156 consecutive patients with dermatitis. In another group of 1056 routinely tested patients data were collected and analyzed regarding factors such as profession, atopy, localization of the dermatitis, and presence of contact allergies., Results: Gold allergy was overrepresented in those having dental gold. In persons with contact allergy to gold a dermatitis on the ears, fingers, or eye area was most frequent., Conclusion: Exposure to gold jewelry and to dental gold may be important in the sensitization and elicitation of dermatitis.

Cases of onychomycosis represent up to 30% of diagnosed superficial fungal infections and are caused by three groups of fungi: dermatophytes, yeasts, and nondermatophytic molds. The majority of toenail infections are caused by dermatophytes; Trichophyton rubrum is isolated with the greatest frequency. In infections of fingernails, Candida species can be isolated as frequently as the dermatophytes. Of the molds, Scytalidium species can infect both fingernails and toenails, as well as adjacent skin, and represent 3% of the nail infections in a temperate country such as the United Kingdom but a much higher proportion in tropical countries. Other molds such as Scopulariopsis, Acremonium, and Aspergillus species can infect damaged nails. The isolation of a dermatophyte is always considered indicative of infection, but the presence of other molds, which may be aerial contaminants, must be interpreted with care.

Background: Rubber additives, mainly vulcanizers and antioxidants, are increasingly a cause of contact dermatitis., Objective: The aim of the present study was to determine the frequency of type IV allergy to rubber additives., Methods: Seven thousand patients seen during a 10-year period were evaluated. Of them, 4680 were patch tested with the standard series recommended by the Spanish Group for Research of Contact Dermatitis (GEIDC) and a series of individual rubber additives., Results: A total of 686 patients (14.7% of those patch tested) had one or more positive reactions to rubber additives. Of these, 582 (84.8%) were men and 104 (15.2%) were women. The incidence of rubber sensitization was especially high among construction workers (47.0%)., Conclusion: Rubber additives are a common cause of occupational contact dermatitis, particularly in construction workers. We postulate that rubber gloves and boots (utilized to avoid contact with sensitizing substances) themselves may be a common cause of contact dermatitis. The high incidence of allergy to some rubber additives, such as thiurams and carbas, indicates that their replacement by other less sensitizing vulcanizers is advisable.

Concern about the increasing incidence of hand dermatitis in floral shop workers in the United States and its possible association to the plant Alstroemeria, a flower that has become popular since its introduction in 1981, prompted investigation of the prevalence and cause of hand dermatitis in a sample of floral workers. Fifty-seven floral workers were surveyed, and 15 (26%) reported hand dermatitis within the previous 12 months. Sixteen floral workers (eight with dermatitis) volunteered to be patch tested to the North American Contact Dermatitis Group Standard and Perfume Trays, a series of eight pesticides and 20 plant allergens. Of four of seven floral designers and arrangers who reported hand dermatitis, three reacted positively to patch tests to tuliposide A, the allergen in Alstroemeria. Patch test readings for all other plant extracts were negative. A positive reading for a test to one pesticide, difolatan (Captafol), was noted, the relevance of which is unknown.

In this study of photosensitivity among psoriasis patients, a questionnaire was mailed to 2000 psoriasis patients living within the service area of Karolinska Hospital, Stockholm. Of the 88% patients who replied, 4.4% stated that their psoriasis always worsened after sun exposure, and 7.3% stated that this was sometimes so. After telephone interviews with an 80% sample of these allegedly photosensitive patients, half of them were considered nonphotosensitive. Thus an estimated prevalence of 5.5% photosensitivity was obtained. Forty-three percent of the light-sensitive patients had a history of polymorphous light eruption with secondary exacerbation of psoriasis lesions. Comparison between the photosensitive and the nonphotosensitive patients concerning background factors and symptoms showed a statistically significant increase (p less than or equal to 0.001) in the photosensitive group concerning skin type I, psoriasis affecting hands, heredity for photosensitivity, and advanced age.