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ADVANCES IN ENVIRONMENTAL DERMATOLOGY

ADVANCES IN ENVIRONMENTAL DERMATOLOGY. HOWARD I. MAIBACH, M.D. DEPARTMENT OF DERMATOLOGY UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SAN FRANCISCO, CA 94143-0989. (UPPER) EYELID CHRONIC DERMATITIS. • F > M • “ANXIOUS” PATIENTS • CORTICOID PHOBIA (LARGELY IATROGENIC)

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ADVANCES IN ENVIRONMENTAL DERMATOLOGY

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  1. ADVANCES IN ENVIRONMENTALDERMATOLOGY HOWARD I. MAIBACH, M.D. DEPARTMENT OF DERMATOLOGY UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SAN FRANCISCO, CA 94143-0989

  2. (UPPER) EYELIDCHRONIC DERMATITIS • F > M • “ANXIOUS” PATIENTS • CORTICOID PHOBIA (LARGELY IATROGENIC) • RO ACD & CUS (UNCOMMON)

  3. CORTICOID PHOBIA –REAL ? • GLAUCOMA • CATARACT BRANCO: CUT & OCULAR TOX

  4. TREATMENT ALGORITHM • EYE EXAM (BEFORE & “AFTER”) • HIGHER POTENCY & CONCENTRATION • RAPIDLY TAPER: - POTENCY - STRENGTH - FREQUENCY • PROGNOSIS: EXCELLENT

  5. ALLERGEN / ANTIGEN QUALITYISOCYANATE (POLYURETHANE’S)NOT STABLESOLUTION:SUPPLIER TRANSPARENCY

  6. ICU –IMMUNOLOGIC CONTACT URTICARIALATEX PROTEINMARKED DECREASE IN FREQUENCYTRIUMPH: COOPERATION –• CHEMICAL ENGINEERING • IMMUNOCHEMISTRY• DERMATOALLERGY

  7. HAND ECZEMA ELEVEN PHENOTYPES HYPERKERATOTIC (PSORIASIFORM) • HYPERKERATOTIC (PSORIASIFORM) • M > F • ~ 4 DECADE ONSET • “PSORIATIC STIGMA” – COMMON

  8. MANAGEMENT • CLASS 1 TOPICAL CORTICOID & OCCLUSION HS • RO ACD (KOEBNER) • LOCALIZED PUVA; ACITRETIN; METHOTREXATE • PROGNOSIS: EXCELLENT (YEARS)

  9. • 29 y/o DENTIST• DORSAL & PALMER “HAND ECZEMA”• LEVEL 4 PATCH TEST: NEGATIVE• NOT UNDER CLINICAL CONTROL• INTERVENTION ?

  10. • REPEAT PATCH TESTING• THIURAM POSITIVE• INTERVENTION: THIURAM “POOR” OR “FREE” GLOVES• RESULT: CLEAR 4 YRS. LATER• MORAL: PATCH TESTING– LIKE BIOPSIES MAY NEED REPEATINGSMENNE: HAND ECZEMA, 2ND EDITION

  11. • 46 y/o PHYSICIAN• PATCHY RECURRENTWIDESPREAD ECZEMA• PATCH TEST: NEGATIVE• NOT UNDER CLINICAL CONTROL• INTERVENTION ?

  12. • REPEAT PATCH TESTING (1 YR LATER)• MC/MCI POSITIVE200 PPM POSITIVE 100 PPM NEGATIVE• RESOLUTION : REMOVED MC/MCI & CLEARED• MORAL: 1) HEALTH CARE WORKERS– OFTEN STOIC 2) EVIDENCE BASED KNOWLEDGE M. BRUZE: MC/MCI PATCH & USE TESTS: IN PRESS

  13. • 40 y/o LAWYER• RECURRENT DERMATITIS– FACE & NECK• PPD +: 1+ (ICDRG)• HAIR DYE +: 1+• “I HAVE TO DYE MY HAIR”• INTERVENTION?

  14. INTERVENTION:• “DO IT– WITH CARE” • BEGINNING OF WEEK • EXPERIENCED TECHNICIAN • ONE CLIENT AT TIME • MINIMIZE DYE: HAIR NOT SCALP • PETROLATUMMORAL:LET’S NOT ALWAYS BE NEGATIVEMcFADDEN: B J D

  15. • 38 y/o PRODUCE GROCER: • CHRONIC ARM & FOREARM ECZEMA• MULTIPLE EPISODES ANAPHYLAXIS– EATING VEGETABLES• PATCH TEST & OPEN TEST: NEGATIVE• INTERVENTION ?

  16. PRICK TEST: + (VEGETABLES)RESOLUTION: 95% IN 6 WKS. (SKIN & EATING)MORAL: DON’T FORGET ICUAMIN: CONTACT URTICARIA SYNDROME, CRC PRESS

  17. HOWARD I. MAIBACH, M.D. PHONE: (415) 673-9693 0700 - 0800 HR SFO TIME MaibachH@derm.ucsf.edu

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