Publications by authors named "Denis Sasseville"

204 Publications

Patch Testing to Methyldibromoglutaronitrile/Phenoxyethanol: North American Contact Dermatitis Group Experience, 1994-2018.

Dermatitis 2021 Mar 5. Epub 2021 Mar 5.

From the Department of Dermatology, Park Nicollet Health Services Department of Dermatology, University of Minnesota Department of Dermatology, Minneapolis Veterans Affairs Medical Center University of Minnesota Medical School, Minneapolis Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, Cleveland Clinic, OH Department of Dermatology, Columbia University Irving Medical School, New York Department of Dermatology, University of California San Francisco Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC Department of Dermatology, Duke University Medical Center, Durham, NC Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada Division of Dermatology, University of Louisville, KY Division of Dermatology, University of Ottawa, Ontario, Canada Department of Dermatology, Keck School of Medicine, Los Angeles, CA Associates in Dermatology, Fort Myers, FL.

Background: Methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) is a broad-spectrum preservative mixture used in consumer and industrial products.

Objectives: The aims of the study were (1) to characterize the prevalence and clinical relevance of patch test reactions to MDBGN/PE and the epidemiology of positive patients and (2) to determine the frequency of concomitant reactions of MDBGN/PE and its components.

Methods: This study used a retrospective analysis of cross-sectional data compiled by the North American Contact Dermatitis Group from 1994 to 2018.

Results: Of 55,477 tested patients, 2674 (4.8%) had positive patch test reactions to MDBGN/PE (1.0%-2.5% petrolatum [pet]); most were + (63.3%) or ++ (22.3%). Clinical relevance was considered definite in 3.0% and probable in 19.3% of reactions. Common dermatitis sites included the hands (26.4%), scattered/generalized distribution (24.7%), and the face (18.3%). Patients with a positive reaction to MDBGN/PE and/or MDBGN and/or PE were significantly more likely to be male and older than 40 years and/or had hand dermatitis (P ≤ 0.0033). Positivity to MDBGN/PE 2.0% pet decreased significantly over time (from 6.0% in 1998-2000 to 2.5% in 2017-2018, P < 0.0001). Personal care products were the most common exposure source (53.2%).

Conclusions: Over time, positivity to MDBGN/PE 2.0% pet decreased significantly from 6.0% (in 1998-2000) to 2.5% (in 2017-2018). The high proportion of weak (63.3%) reactions underscore the need for careful interpretation of patch test sites. Important demographic associations included male sex and age older than 40 years.
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http://dx.doi.org/10.1097/DER.0000000000000732DOI Listing
March 2021

Prevalence and Trend of Allergen Sensitization in Patients with Nummular (Discoid) Eczema Referred for Patch Testing, North American Contact Dermatitis Group Data, 2001-2016.

Contact Dermatitis 2021 Feb 26. Epub 2021 Feb 26.

Department of Dermatology, Pennsylvania State University, State College.

Background: Few studies examined the relationship between nummular (discoid) eczema (NE) and allergic contact dermatitis (ACD).

Objective: To examine the trends, associations, and clinical relevance of ACD in NE patients referred for patch testing.

Methods: Retrospective analysis of 38,723 patients from the North American Contact Dermatitis Group.

Results: Overall, 748 (1.9%) patients were diagnosed with NE; 23.9% had a concomitant diagnosis of ACD. The prevalence of NE fluctuated over time between 2001-2016, with no overall change in prevalence in diagnosed NE. In multivariable logistic regression models, NE steadily increased with age and was associated with male sex, Asian and other race/ethnicity, and inversely associated with a history of AD and hay fever. Patients with NE had lower proportions of ≥1 positive allergic reaction and lower odds of a positive reaction in multiple, individual allergens. The most commonly relevant allergens in patients with NE were formaldehyde 2.0% aq., methylisothiazolinone, quaternium-15, fragrance mix I, and propylene glycol.

Conclusion: NE is a heterogeneous disorder with distinct subsets of lesional distribution and profile of relevant allergens, especially formaldehyde and formaldehyde releasers. Nearly 1 in 4 NE patients had ACD, supporting the role of patch testing in NE patients. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/cod.13824DOI Listing
February 2021

Incidence and Mortality of Prostate Cancer in Canada during 1992-2010.

Curr Oncol 2021 Feb 21;28(1):978-990. Epub 2021 Feb 21.

Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada.

In Canada, prostate cancer is the most common reportable malignancy in men. We assessed the temporal trends of prostate cancer to gain insight into the geographic incidence and mortality trends of this disease. Three independent population-based cancer registries were used to retrospectively analyze demographic data on Canadian men diagnosed with prostate cancer and men who died of prostate cancer between the years of 1992 and 2010. The incidence and mortality rates were calculated at the provincial, city, and forward sortation area (FSA) postal code levels by using population counts that were obtained from the Canadian Census of Population. The Canadian average incidence rate was 113.57 cases per 100,000 males. There has been an overall increasing trend in crude prostate cancer incidence between 1992 and 2010 with three peaks, in 1993, 2001, and 2007. However, age-adjusted incidence rates showed no significant increase over time. The national mortality rate was calculated to be 24.13 deaths per 100,000 males per year. A decrease was noted in crude and age-adjusted mortality rates between 1992 and 2010. Several provinces, cities, and FSAs had higher incidence/mortality rates than the national average. Several of the FSA postal codes with the highest incidence/mortality rates were adjacent to one another. Several Canadian regions of high incidence for prostate cancer have been identified through this study and temporal trends are consistent with those reported in the literature. These results will serve as a foundation for future studies that will seek to identify new regional risk factors and etiologic agents.
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http://dx.doi.org/10.3390/curroncol28010096DOI Listing
February 2021

Contact dermatitis associated with preservatives: Retrospective analysis of North American Contact Dermatitis Group data, 1994 through 2016.

J Am Acad Dermatol 2021 Feb 9. Epub 2021 Feb 9.

Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota; Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.

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.
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http://dx.doi.org/10.1016/j.jaad.2020.07.059DOI Listing
February 2021

Patch Testing With Carmine 2.5% in Petrolatum by the North American Contact Dermatitis Group, 2011-2012.

Dermatitis 2021 Jan 11. Epub 2021 Jan 11.

From the Department of Dermatology, Park Nicollet Health Services Department of Dermatology, University of Minnesota Department of Dermatology, Minneapolis Veterans Affairs Medical Center University of Minnesota Medical School, Minneapolis Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada Department of Dermatology, Cleveland Clinic, OH Department of Dermatology, Duke University Medical Center, Durham, NC Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC Department of Dermatology, University of California, San Francisco Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada Division of Dermatology, University of Louisville, KY Division of Dermatology, University of Ottawa, Ontario, Canada Associates in Dermatology, Fort Myers, FL Department of Dermatology, Columbia University, New York, NY Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.

Background: Carmine is a natural red dye that may cause allergic contact dermatitis.

Objective: The aim of this study was to analyze patch test reactions to carmine (2.5% in petrolatum) and characterize carmine-positive patients.

Methods: This study conducted a retrospective analysis of North American Contact Dermatitis Group data compiled between 2011 and 2012.

Results: Of 4240 patients patch tested to carmine, 132 (3.1%) had reactions with a final interpretation of "allergic" (positive). Carmine-positive patients were significantly more likely to be female (77.7% vs 68.3%; P = 0.0237) and have a final primary diagnosis of allergic contact dermatitis (74.8% vs 47.2%; P < 0.0001). As compared with carmine-negative patients, carmine-positive patients were significantly more likely to have involvement of all facial sites combined (48.1% vs 29.9%; P < 0.0001) and the lips (7.6% vs 3.6%; P = 0.0166). At final reading, most carmine reactions were weak (+; 64.9%). Approximately half (53.4%) were currently clinically relevant; identified sources were primarily personal care products (77.1%), especially makeup (31.4%) and lip products (8.6%).

Conclusions: Weak patch test reactions to carmine should be interpreted with caution. Allergic contact dermatitis to carmine should be suspected in women with facial and/or lip dermatitis, especially those using carmine-containing cosmetics.
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http://dx.doi.org/10.1097/DER.0000000000000643DOI Listing
January 2021

Patch Testing With a New Composition of the Mercapto Mix-A Multicenter Study from the International Contact Dermatitis Research Group.

Dermatitis 2021 Jan 5;Publish Ahead of Print. Epub 2021 Jan 5.

From the Department of Occupational Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark Clinicas Hospital, Dermatology Department Buenos Aires, Argentina Department of Dermatology, University Clinic Jena, Germany National Skin Centre, Singapore Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Portugal University Hospital KU Leuven, Dermatology, Belgium Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Croatia University of Ottawa, The Ottawa Hospital, Ottawa, Canada Institute of Dermatology, Bangkok, Thailand Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Ottawa, Canada Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.

Background: Mercaptobenzothiazole compounds are associated with allergic contact dermatitis caused by rubber products. Several screening substances have been used for patch testing.

Objective: To compare the frequency of positive test reactions to a mercapto mix containing a higher concentration of 2-mercaptobenzothiazole with reactions to the combination of 2-mercaptobenzothiazole 2.0% and mercapto mix 2.0%.

Methods: There were 7103 dermatitis patients in 12 International Contact Dermatitis Research Group dermatology departments who were patch tested with 2-mercaptobenzothiazole 2.0% petrolatum (pet.), mercapto mix 2.0% pet., and mercapto mix 3.5% pet.

Results: Contact allergy to the 3 test preparations varied among the 12 centers: 2-mercaptobenzothiazole 2.0% pet. (0-2.4%), mercapto mix 2.0% pet. (0-4.9%), and mercapto mix 3.5% pet. (0-1.4%). 2-Mercaptobenzothiazole 2.0% and mercapto mix 2.0% detected a few more positive patients compared with mercapto mix 3.5%, but the difference was statistically insignificant (mercapto mix 2.0% pet., P = 1.0; 2-mercapto-benzothiazole 2.0% pet., P = 0.66).

Conclusions: Mercapto mix 3.5% pet. is not better than 2-mercaptobenzothiazole 2.0% and mercapto mix 2.0% by a difference that is significant. By using only 1 test preparation (mercapto mix 3.5%), an additional hapten could be tested. No cases of suspected/proven patch test sensitization were registered.
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http://dx.doi.org/10.1097/DER.0000000000000669DOI Listing
January 2021

Patch Testing With Methylchloroisothiazolinone/Methylisothiazolinone Using a New Diagnostic Mix-A Multicenter Study From the International Contact Dermatitis Research Group.

Dermatitis 2021 Jan 5;Publish Ahead of Print. Epub 2021 Jan 5.

From the Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden Dermatovenerology and Allergy Centre, Odense University Hospital, University of Southern Denmark Department of Dermatology, Jena University Hospital, Germany National Skin Centre, Singapore Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Portugal Department of Dermatology, University Hospital KU Leuven, Belgium Department of Dermatology and Venereology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Croatia University of Ottawa, The Ottawa Hospital, Ontario, Canada Institute of Dermatology, Bangkok, Thailand Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Québec, Canada Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi.

Background: In the early 1980s, a preservative containing a mixture of methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) in a ratio of 3:1 was introduced. This mixture (mix) has been patch tested at 100 ppm (0.01%) worldwide and at 200 ppm (0.02%) in Sweden since 1986 and also in the European baseline series since 2014.

Objective: A new aqueous mix of MCI 0.015% and MI 0.2% was compared with patch testing with the 2 aqueous baseline preparations of MCI/MI 0.02% and MI 0.2%.

Methods: Four thousand three hundred ninety-seven patients with dermatitis in 12 International Contact Dermatitis Research Group dermatology departments from 3 continents were patch tested simultaneously with the 3 preparations.

Results: The frequency of positive patch tests to the allergens varied between 0% and 26.7% in the 12 test centers. The new mixture MCI/MI 0.215% in aqua (aq) detected significantly more patients with MCI/MI allergy than both MCI/MI 0.02% aq (P < 0.001) and MI 0.2% aq (P < 0.001) alone and combined.

Conclusions: The results favor replacing the preparations MCI/MI 0.02% aq and MI 0.2% aq with the mixture MCI/MI 0.215% aq in the International Contact Dermatitis Research Group baseline series.
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http://dx.doi.org/10.1097/DER.0000000000000657DOI Listing
January 2021

Acetophenone Azine.

Dermatitis 2021 Jan-Feb 01;32(1):5-9

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada.

Acetophenone azine (CAS 729-43-1) was recently discovered as a potent allergen in shin pads and footwear containing the foam elastomer ethyl vinyl acetate. The compound is probably not intentionally added to ethyl vinyl acetate but is likely the result of reactions between other additives that take place during the manufacturing process. A patch testing concentration of 0.1% in acetone or petrolatum is recommended. Acetophenone azine should be part of patch testing shoe series, as well as plastics and glues series. The compound is not currently available from patch testing materials suppliers, a situation that hopefully will be corrected.
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http://dx.doi.org/10.1097/DER.0000000000000697DOI Listing
December 2020

Patch Testing of Mercaptobenzothiazole and Mercapto Mix: The North American Contact Dermatitis Group Experience, 1994-2016.

Dermatitis 2020 Dec 1. Epub 2020 Dec 1.

Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Objectives: Mercapto compounds are a category of rubber accelerators that may cause allergic contact dermatitis. This study characterizes patch test reactions to mercaptobenzothiazole (MBT) and mercapto mix (MM) in a large North American population.

Methods: The 1994-2016 North American Contact Dermatitis Group screening series data were analyzed. Patients with allergic reactions to either MBT or MM (mercapto+) were included. The following characteristics were analyzed: strength of reaction, clinical and occupational relevance, coreactivity with other rubber accelerators, and sources of exposure.

Results: A total of 49,795 patients were tested to mercapto compounds from 1994 to 2016; 633 (1.3%) had positive reactions to MBT and/or MM. The frequency to both MBT and MM significantly decreased over time (P < 0.0001). Mercapto+ patients were significantly more likely to be male, have occupationally related skin disease, and report involvement of the hands and/or feet (P < 0.0001). They were significantly less likely to have face, scalp/ears/neck, or trunk involvement (P ≤ 0.0001). There was significant coreactivity with carba mix (23.4%) and thiuram mix (32.5%). Mercaptobenzothiazole and MM reactions were frequently clinically (81.7% and 83.5%, respectively) and occupationally relevant (29.8% and 33.4%, respectively). Gloves were the most common source (31.3% and 30.9%, respectively).

Conclusions: Patch test positivity to mercapto compounds significantly decreased from 1994 to 2016 but remains clinically and occupationally relevant.
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http://dx.doi.org/10.1097/DER.0000000000000675DOI Listing
December 2020

Fragrance- and Botanical-Related Allergy and Associated Concomitant Reactions: A Retrospective Analysis of the North American Contact Dermatitis Group Data 2007-2016.

Dermatitis 2021 Jan-Feb 01;32(1):42-52

Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.

Importance: When fragrance- and botanical-related (F/BR) allergy is identified, concomitant reaction (CR) frequencies can help direct avoidance recommendations.

Objective: This study aimed to determine the CR rates for F/BR allergens.

Design: A retrospective cross-sectional analysis of the North American Contact Dermatitis Group data 2007-2016 was conducted. Frequencies of demographics, positive reactions, strength of reactions, trends, and CR rates were calculated.

Results: A total of 5504 (22.7%) of 24,246 patients had F/BR allergic reactions. The F/BR-sensitive patients were more likely to be female, older than age 40 years, and White and have face, leg, or anal/genital dermatitis. Top allergens included fragrance mix I (FMI, 10.6%), Myroxylon pereirae (balsam of Peru [BOP], 8%), and fragrance mix II (FMII, 4.9%). There were increasing trends for FMI, FMII, cinnamic aldehyde, and Compositae mix and decreasing trends for BOP and propolis. When patients were positive to any F/BR allergen, they were likely to be positive to FMI, FMII, and BOP. Concomitant reactions were bidirectional between multiple fragrance allergens and propolis, colophony, and Compositae mix.

Conclusions: Concomitant reactions were identified between fragrances, between fragrances and BR allergens, and between BR allergens and fragrances. If CRs of greater than 10% suggest cross-reactivity, then all patients with fragrance sensitivity should avoid BR allergens and vice versa.
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http://dx.doi.org/10.1097/DER.0000000000000661DOI Listing
December 2020

Comparison of Different Metal Salts: Nickel Sulfate 2.5% Versus 5% and Palladium Chloride Versus Sodium Tetrachloropalladate.

Dermatitis 2020 Dec 1. Epub 2020 Dec 1.

From the Division of Dermatology McGill University Health Centre Montreal General Hospital Quebec, Canada E-mail:

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http://dx.doi.org/10.1097/DER.0000000000000662DOI Listing
December 2020

Positive Patch Test Reactions to Carba Mix and Thiuram Mix: The North American Contact Dermatitis Group Experience (1994-2016).

Dermatitis 2020 Dec 1. Epub 2020 Dec 1.

Department of Dermatology, Keck School of Medicine, Los Angeles, CA.

Background/objective: This study characterizes concomitant reactions to carba mix (CM) and thiuram mix (TM) in a large North American population. Because thiurams and dithiocarbamates have structural similarity, concomitant reactions are expected.

Methods: The 1994-2016 North American Contact Dermatitis Group data were analyzed. Patients with a final reaction interpreted as "allergic" to either CM or TM were included.

Results: A total of 49,758 patients were tested to both CM and TM. A total of 3437 (6.9%) had positive reactions to CM and/or TM including the following groups: CM+ only (n = 1403, 40.8%), TM+ only (n = 1068, 31.0%), or both (n = 966, 28.1%). A total of 47.5% of TM+ patients were positive to CM and 40.8% of CM+ patients were positive to TM. Male sex, occupationally related dermatitis, and hand involvement were significantly more common in individuals positive to CM and/or TM as compared with those who were negative (P < 0.0001). More than 80% of CM+/TM+ reactions were currently relevant. Gloves were the most common source of CM and TM; clothing and footwear were also frequent.

Conclusions: Carba mix and TM remain important, clinically relevant allergens. Although significant concomitant reaction frequency was demonstrated, more than half of the patients reacting to either CM or TM would have been missed if both had not been tested, underscoring the importance of testing to both.
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http://dx.doi.org/10.1097/DER.0000000000000648DOI Listing
December 2020

Hand Dermatitis in Adults Referred for Patch Testing: Analysis of North American Contact Dermatitis Group Data, 2000-2016.

J Am Acad Dermatol 2020 Nov 28. Epub 2020 Nov 28.

Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.

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 were diagnosed with HE, with differences of overlap between allergic contact, irritant contact and atopic dermatitis. Allergic contact HE fluctuated, while 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%; Chi-square, P<0.0001). 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.
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http://dx.doi.org/10.1016/j.jaad.2020.11.054DOI Listing
November 2020

Erythema multiforme-like eruption associated with plant-induced allergic contact dermatitis in a pediatric patient: A case report.

Pediatr Dermatol 2021 Jan 28;38(1):246-248. Epub 2020 Nov 28.

Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada.

An 11-year-old boy presented to the emergency department 5 days after playing in the forest. His initial eruption, consistent with allergic contact dermatitis to poison ivy, progressed into target lesions involving his extremities, palms, upper trunk, and face, consistent with an erythema multiforme-like eruption. This report details the case and reviews the literature concerning this atypical and potentially underreported complication of plant-induced allergic contact dermatitis.
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http://dx.doi.org/10.1111/pde.14450DOI Listing
January 2021

Patch Testing to Diphenylguanidine by the North American Contact Dermatitis Group (2013-2016).

Dermatitis 2020 Nov/Dec;31(6):350-358

From the *Department of Dermatology, Park Nicollet Health Services †Department of Dermatology, University of Minnesota ‡Department of Dermatology, Minneapolis Veterans Affairs Medical Center §University of Minnesota Medical School, Minneapolis ∥Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada ¶Division of Dermatology, University of Louisville, KY **Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC ††Department of Dermatology, Duke University, Durham, NC ‡‡Department of Dermatology, Cleveland Clinic, OH §§Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison ∥∥Department of Dermatology, University of California San Francisco ¶¶Division of Dermatology, Montreal General Hospital, McGill University, Quebec, Canada ***Department of Dermatology, Columbia University, New York, NY †††Department of Dermatology, Keck School of Medicine, Los Angeles, CA ‡‡‡Division of Dermatology, University of Ottawa, Ontario, Canada §§§Department of Dermatology, Pennsylvania State University, State College ∥∥∥Department of Dermatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH ¶¶¶Department of Specialty Medicine, Ohio University, Columbus.

Background/objectives: Carba mix (CM, 3% petrolatum) contains 1,3-diphenylguanidine (DPG, 1%), zinc diethyldithiocarbamate (1%), and zinc dibutyldithiocarbamate (1%). Because DPG is a component of CM, DPG is often not tested separately. The purpose of this study was to determine the frequency of concomitant reactions to CM and DPG.

Methods: A retrospective analysis of the 2013-2016 North American Contact Dermatitis Group data was conducted. The study group consisted of patients with final interpretation of "allergic" to either DPG or CM. Reactions coded as irritant or doubtful/macular erythema (+/- and not interpreted as allergic) were excluded.

Results: A total of 10,457 patients were patch tested to both CM and DPG, and 610 (5.8%) had allergic reactions to either CM or DPG (CM only [n = 292, 47.9%], DPG only [n = 190, 31.1%], both [n = 128, 21.0%]). A total of 39.4% of CM-allergic patients reacted to DPG, and 59.7% of DPG-allergic patients reacted to CM. Analyses found that 25% (++/+++ subgroup) to 40% (all patients) of allergic reactions to DPG would have been missed by testing to CM alone. More than 70% of reactions to CM and DPG were +/- or +.

Conclusions: Patch testing to CM will miss 25% to 40% of positive reactions to DPG. Both CM and DPG have a high frequency of +/- and + reactions.
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http://dx.doi.org/10.1097/DER.0000000000000629DOI Listing
November 2020

Expanding Patch Testing Beyond the Baseline Series: Usefulness of Customized Antimicrobials, Vehicles, and Cosmetics Series.

Dermatitis 2020 Nov/Dec;31(6):367-372

From the Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada.

Background: Testing cosmetics and their ingredients is essential to avoid missing relevant allergens and to monitor fluctuating incidence of hypersensitivity.

Objective: The aim of this study was to review the usefulness of patch testing with a customized antimicrobials, vehicles, and cosmetics (AVC) series over 15 years at a single Canadian site.

Methods: Between January 1, 2005, and December 31, 2019, patients suspected of having cosmetics allergy were patch tested with a 40-allergen AVC series in addition to the North American Contact Dermatitis Group standard screening series. We reviewed the patch test results of 2868 patients.

Results: We consecutively patch tested with the baseline series 6103 patients, of which 2868 (47%) were also tested with the AVC series. Of 53 different allergens that were tested at some point, 26 remained in the series throughout the 15-year span. The most common positive allergens were thimerosal (4.52%), polyvidone-iodine (2.25%), propolis (2.06%), sodium metabisulfite (1.94%), dodecyl gallate (1.53%), carmine (1.10%), lauryl glucoside (1.01%), sandalwood oil (0.7%), and tert-butylhydroquinone (0.7%).

Conclusions: Although the expansion of the North American Contact Dermatitis Group standard screening series has decreased the yield from the AVC series from 21.1% to 13.9%, it still remains a useful adjunct for patients suspected of having cosmetics or disinfectants allergy.
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http://dx.doi.org/10.1097/DER.0000000000000674DOI Listing
October 2020

Contact Dermatitis to Personal Care Products is Increasing (but Different!) in Males and Females: North American Contact Dermatitis Group (NACDG) Data, 1996-2016.

J Am Acad Dermatol 2020 Oct 8. Epub 2020 Oct 8.

Division of Dermatology, University of Ottawa, Ontario, Canada.

Background: Personal care products(PCPs) are commonly responsible for allergic(ACD) and irritant contact dermatitis(ICD). PCP use was historically associated with women but increasingly, male-targeted PCPs are being marketed.

Objective: To characterize and compare males and females with PCP-related contact dermatitis(MPCP, FPCP).

Methods: Retrospective cross-sectional analysis of North American Contact Dermatitis Group(NACDG) data (1996-2016).

Results: 4680/16,233 males (28.8%) and 12,730/32,222 (39.5%) females had a PCP identified as a source of ICD or a positive patch test reaction. The proportion of PCP-related dermatitis in both sexes significantly increased (>2.7 fold) over the decade of study. As compared to FPCP, a larger proportion of MPCP were older and/or had trunk/extremity dermatitis(p<0.0001). MPCP were twice as likely to have soaps as a source while FPCP were twice as likely to have hair care products(p values<0.001). The most common PCP-related NACDG allergens for both sexes were methylisothiazolinone(MI) (MPCP:28.8%, FPCP:21.5%), fragrance mix I (22.3%, 20.1%), balsam of Peru (18.5%, 14.1%), quaternium-15 (16.1%, 12.3%), and paraphenylenediamine (11.5%, 11.1%).

Limitations: Patient population referred for suspected contact dermatitis.

Conclusions: PCP-related dermatitis is increasing. Sites of involvement and relevant PCP sources are distinct between sexes. Male and female variation in exposure history may explain differences in reactivity to some allergen groups.
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http://dx.doi.org/10.1016/j.jaad.2020.10.003DOI Listing
October 2020

Scalp Involvement in Patients Referred for Patch Testing: Retrospective Cross-Sectional Analysis of North American Contact Dermatitis Group Data, 1996 to 2016.

J Am Acad Dermatol 2020 Aug 18. Epub 2020 Aug 18.

Associates in Dermatology, Fort Myers, FL.

Background: Scalp conditions are often multifactorial.

Objective: To characterize patients with scalp involvement and patch testing outcomes.

Methods: Retrospective cross-sectional analysis of North American Contact Dermatitis Group data (1996-2016). Study groups included patients with scalp involvement (<3 anatomic sites coded) with or without additional sites.

Results: 4.8% (2,331/48,753) had scalp identified as one of up to three affected anatomic sites. Roughly one-third of "scalp-only" individuals had a specific primary diagnosis of allergic contact dermatitis (ACD) (38.6%), followed by seborrheic dermatitis (17.2%) and irritant contact dermatitis (9.3%). When adjacent anatomical sites were affected, ACD was more frequently identified as the primary diagnosis (>50%). The top 5 currently clinically relevant allergens in scalp-only patients were p-phenylenediamine, fragrance mix I, nickel sulfate, balsam of Peru, and cinnamic aldehyde. Methylisothiazolinone sensitivity was notable when adjacent anatomical sites were involved. Top 3 specifically identified sources for scalp-only allergens were hair dyes, shampoo/conditioners, and consumer items (e.g. hair appliances, glasses).

Limitations: Tertiary referral population.

Conclusion: Isolated scalp involvement was less likely to be associated with ACD than when adjacent anatomical sites were involved. Overlap with multiple diagnoses was frequent including seborrheic dermatitis, irritant dermatitis, and/or other dermatoses. P-phenylenediamine was the most common allergen.
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http://dx.doi.org/10.1016/j.jaad.2020.08.046DOI Listing
August 2020

Hypopigmented Mycosis Fungoides: Loss of Pigmentation Reflects Antitumor Immune Response in Young Patients.

Cancers (Basel) 2020 Jul 22;12(8). Epub 2020 Jul 22.

Division of Experimental Medicine, McGill University, Montreal, QC H4A3J1, Canada.

Hypopigmented mycosis fungoides (HMF) is a form of cutaneous T-cell lymphoma (CTCL), a heterogeneous group of extranodal non-Hodgkin's lymphomas. HMF has a unique set of defining features that include light colored to achromic lesions, a predilection for darker skin phototypes, an early onset of disease, and predominance of CD8 T-cells, among others. In the current review, we detail the known pathways of molecular pathogenesis for this lymphoma and posit that an active Th1/cytotoxic antitumor immune response in part explains why this variant is primarily seen in children/adolescents and young adults, who do not exhibit signs of immunosenescence. As a result of this potent cytotoxic response, HMF patients experience mostly favorable overall prognosis, while hypopigmentation may in fact represent a useful surrogate marker of cytotoxic immunity targeting the malignant cells. Understanding the molecular processes behind the specific features that define HMF may lead to improved diagnostic accuracy, personalized prognosis by risk stratification, and improved management of HMF. Moreover, improving our knowledge of HMF may aid our further understanding of other cutaneous lymphomas.
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http://dx.doi.org/10.3390/cancers12082007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465783PMC
July 2020

Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016.

J Am Acad Dermatol 2020 Jul 15. Epub 2020 Jul 15.

Department of Dermatology, Keck School of Medicine, Los Angeles, California.

Background: Eyelid dermatitis is a common dermatologic complaint.

Objective: To characterize patients with eyelid dermatitis.

Methods: Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data.

Results: Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group.

Limitations: Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data.

Conclusion: Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.
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http://dx.doi.org/10.1016/j.jaad.2020.07.020DOI Listing
July 2020

Contact Dermatitis Associated With Nail Care Products: Retrospective Analysis of North American Contact Dermatitis Group Data, 2001-2016.

Dermatitis 2020 May/Jun;31(3):191-201

Department of Dermatology, Ohio State University, Columbus.

Background: Ingredients in nail care products may lead to allergic and/or irritant contact dermatitis.

Objective: The aims of this study were to determine frequency of contact dermatitis associated with nail care products, characterize associated body sites, and describe causative allergens.

Methods: A retrospective analysis was conducted with the North American Contact Dermatitis Group data between 2001 and 2016.

Results: Of the 38,775 patients tested, 769 (2.0%) had: 1) more than 1 allergic patch test reaction associated with a nail care product (n = 746), 2) irritant contact dermatitis associated with a nail care product (n = 14), or 3) both (n = 9). Primary body sites included the face (43.0%) and hands (27.6%). The top 5 allergens were (2-hydroxyethyl methacrylate (273/482, 56.6%), methyl methacrylate (210/755, 27.8%), ethyl acrylate (190/755, 25.2%), ethyl-2-cyanoacrylate (12/175, 6.9%) and tosylamide (273/755, 36.2%). Frequency of allergy to 2-hydroxyethyl methacrylate (P = 0.0069) and ethyl acrylate (P = 0.0024) significantly increased over the study period, whereas allergy secondary to tosylamide significantly decreased (P < 0.0001).

Conclusions: As long-lasting nail techniques become widespread, the prevalence of contact dermatitis to nail care products is expected to increase. Almost one-fifth of nail care product-associated allergens would have been missed without additional screening allergens beyond the North American Contact Dermatitis Group series, underscoring the need for testing to a broad array of allergens.
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http://dx.doi.org/10.1097/DER.0000000000000583DOI Listing
May 2020

Contact Allergy to Fragrance Mix II and Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde: A Retrospective Study by International Contact Dermatitis Research Group.

Dermatitis 2020 Jul/Aug;31(4):268-271

Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada.

Background: Fragrance mix II (FM II) is included in the baseline patch test series recommended by the International Contact Dermatitis Research Group (ICDRG). Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) is the most important sensitizer of the 6 fragrance materials included in FM II. Besides being a part of FM II, HICC is also tested separately in the ICDRG baseline series.

Objectives: The aim of the study was to investigate the prevalence of contact allergy to FM II and HICC in 2012-2016 with a focus on simultaneous reactions and the percentage of missed contact allergy to HICC provided that only FM II had been tested.

Patients And Methods: A total of 25,019 consecutive dermatitis patients in 13 dermatology clinics representing 12 countries in 5 continents were patch tested with FM II and HICC in the baseline series.

Results: Contact allergy to FM II and HICC was found in 3.9% and 1.6%, respectively. For FM II, the frequency varied from 1.5% to 7.6% in different centers. The corresponding range for HICC was 0.2% to 3.6%. Simultaneous contact allergy to FM II and HICC was noted in 1.4% with the range 0.2% to 2.6%. Seventy-seven patients (0.31%) with contact allergy to HICC did not test positively to FM II. The range for missed HICC allergy by testing only FM II in the different centers would be 0.04% to 0.74%. The ratio between the contact allergy rates for FM II and HICC was similar for all centers, except for Montreal having significantly more contact allergy to FM II than to HICC.

Conclusions: The frequency of missed contact allergy to HICC when testing only with FM II was less than 0.5%, therefore questioning the need to test HICC separately in the ICDRG baseline series.
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http://dx.doi.org/10.1097/DER.0000000000000545DOI Listing
April 2020

Epidemiology and Patient Distribution of Oral Cavity and Oropharyngeal SCC in Canada.

J Cutan Med Surg 2020 Jul/Aug;24(4):340-349. Epub 2020 Apr 2.

5620 Division of Dermatology, McGill University, Montreal, QC, Canada.

Background: Oral cavity cancers (OCCs) and oropharyngeal cancers (OPCs) continue to be a major source of morbidity and mortality worldwide requiring the shared effort of numerous specialists. Tobacco and alcohol consumption have long been identified as risk factors for both OCC and OPC. In addition, human papilloma virus (HPV) is gaining its position as the main causal agent for OPC.

Objective: The objective of this study is to analyze the epidemiology of OCC and OPC in Canada.

Methods: Data pertaining to the year of diagnosis, the patient's sex, age at the time of diagnosis, province/territory, city and postal code of oral cavity, and oropharyngeal malignancies diagnosed during 1992-2010 were extracted from the Canadian Cancer Registry and Le Registre Québécois du Cancer.

Results: In total, 21 685 OCC cases and 15 965 OPC cases were identified from 1992 to 2010. Of those, 84.97% were oral cavity squamous cell carcinomas (SCCs), 88.10% were oropharyngeal SCCs, and both had a significant male predominance. While oral cavity SCC incidence stabilized over the study period, oropharyngeal SCC continued to increase. Oral cavity SCC incidence increased with age, while oropharyngeal SCC incidence peaked in the 50- to 59-year age group. Detailed geographic distribution analysis of patients at the provincial/territorial, city, and postal code levels identified several patient clusters.

Conclusions: This work highlights important epidemiological differences in trends between oral and oropharyngeal cancers, identifies high-incidence postal codes for each malignancy, and correlates incidence/mortality with known risk factors including alcohol/tobacco use and HPV infections, therefore providing a comprehensive understanding of epidemiology for these cancers in Canada.
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http://dx.doi.org/10.1177/1203475420915448DOI Listing
April 2020

In silico analyses of the tumor microenvironment highlight tumoral inflammation, a Th2 cytokine shift and a mesenchymal stem cell-like phenotype in advanced in basal cell carcinomas.

J Cell Commun Signal 2020 Jun 21;14(2):245-254. Epub 2020 Mar 21.

Division of Dermatology, McGill University Health Centre, Rm. E02.6236, 1001 Decarie Blvd, Montréal, Québec, H4A 3J1, Canada.

Basal Cell Carcinoma (BCC) represents the most common form of all cancers. BCC is characteristically surrounded by a fibromyxoid stroma. Previous studies have suggested a shift towards a Th2 response, an increase in T regulatory lymphocytes and the presence of cancer-associated fibroblasts in the BCC tumor microenvironment. In this study, we aimed to further characterize the BCC tumor microenvironment in detail by analyzing BCC RNA-Sequencing data and correlating it with clinically-relevant features via in silico RNA deconvolution. Using immune cell type deconvolution by CIBERSORT, we have identified a brisk lymphocytic infiltration, and more abundant macrophages in BCC tumors compared to normal skin. Using cell type enrichment by xCell, we confirmed the observed immune infiltration in BCC tumors and compared them to normal skin. We observed a shift towards Th2 immunity in advanced and vismodegib-resistant tumors. Tumoral inflammation induced by macrophage activity was associated with advanced BCCs, while lymphocytic infiltration was most significant in non-advanced tumors, likely related to an adaptive anti-tumoral response. In advanced and vismodegib-resistant BCCs, mesenchymal stem cell-like properties were observed. Particularly in vismodegib-resistant BCCs, fibroblasts and adipocytes were found at high number, which ultimately may contribute to the decreased drug delivery to the tumor. In conclusion, this study has revealed notable BCC tumor microenvironment findings associated with important clinical features. Microenvironment-altering agents may be used locally for "routine" BCCs and systematically for advanced or resistant BCCs.
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http://dx.doi.org/10.1007/s12079-020-00563-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272519PMC
June 2020

Severe allergic contact blepharitis from propolis.

Contact Dermatitis 2020 Jun 23;82(6):399-400. Epub 2020 Mar 23.

Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.

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http://dx.doi.org/10.1111/cod.13484DOI Listing
June 2020

Allergic contact dermatitis from acetophenone azine in a Canadian child.

Contact Dermatitis 2020 Jul 5;83(1):41-42. Epub 2020 Mar 5.

Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montréal, Quebec, Canada.

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http://dx.doi.org/10.1111/cod.13504DOI Listing
July 2020

Symmetrical drug-related intertriginous and flexural exanthema secondary to epidermal growth factor receptor inhibitor gefitinib.

JAAD Case Rep 2020 Mar 18;6(3):172-175. Epub 2020 Feb 18.

Department of Medicine, Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1016/j.jdcr.2017.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029338PMC
March 2020

Epidemiology of invasive ocular surface squamous neoplasia in Canada during 1992-2010.

Br J Ophthalmol 2020 10 16;104(10):1368-1372. Epub 2020 Jan 16.

Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada

Background: Ocular surface squamous neoplasia (OSSN) is the most common non-pigmented ocular surface malignancy. It is classified as invasive OSNN (IOSSN) when the underlying stroma are infiltrated by dysplastic squamous epithelial cells through the basement membrane. Here, we present the descriptive epidemiology and geographical distribution of IOSSN in Canada.

Methods: We determined the incidence and geographical distribution of IOSSN cases diagnosed between 1992 and 2010 using two independent population-based cancer registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer.

Results: The mean annual age-standardised incidence rate (WHO 2000-2025) of IOSSN for 1992-2010 was 0.45 cases per million individuals per year with an average annual percent increase in incidence of 4.5%. IOSSN localisation to the conjunctiva was documented in at least 57% of the reported cases. IOSSN exhibited a male predilection ratio of 3.3:1.0 with a mean age at diagnosis of 69 years. Incidence rates of IOSSN across Canadian provinces and cities showed no significant differences from the crude national average.

Conclusions: Our results, particularly concerning IOSSN patient age and male predilection, corroborate with data reported from the USA. Additional studies are needed to determine whether the observed increase in incidence rate over the study period (1992-2010) is significant.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314650DOI Listing
October 2020

Revised Baseline Series of the International Contact Research Group.

Dermatitis 2020 Jan/Feb;31(1):e5-e7

Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden Allergy Center and Department of Dermatology, and Allergy Centre, University Hospital, School of Medicine, Republic University, Montevideo, Uruguay Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark Dermatology Department, Buenos Aires University, Clinicas Hospital, Argentina Occupational Dermatology, Ruprecht-Karls-University, Heidelberg, Germany Department of Dermatology, University Clinic Jena, Germany National Skin Centre, Singapore Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Portugal University Hospital KU Leuven, Dermatology, Leuven, Belgium Department of Dermatology and Venereology, University Hospital Center Zagreb, University of Zagreb School of Medicine, Croatia Department of Dermatology, MGM Medical College, Navi Mumbai, Maharashtra, India Faculty of Medicine and Dentistry, Catholic University of Louvain, Belgium Department of Dermatology, The Catholic University of Korea, Seoul, South Korea Department of Dermatology, UCSF School of Medicine, San Francisco, California. Department of Integrative Medical Science for Allergic Disease, Fujita Health University School of Medicine, Nagoya, Japan Department of Cutaneous Allergy, St John's Institute of Dermatology, London, United Kingdom Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc, Melbourne, Victoria, Australia University of Ottawa, The Ottawa Hospital, Ontario, Canada Institute of Dermatology, Bangkok, Thailand Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Quebec, Canada Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India Lund University, Department of Occupational and Environmental Dermatology, Skåne University Hospital, Malmö, Sweden.

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http://dx.doi.org/10.1097/DER.0000000000000532DOI Listing
January 2020