SDEF Women’s & Pediatric Dermatology Seminar

The use of JAK inhibitors is not the only notable development in the treatment of hair loss; light-based options show potential as well, according to Maria Hordinsky, MD.

“Although the precise mechanism remains unclear, it has been postulated that photobiomodulation acts through oxidative metabolism and transcription factor stimulation,” Dr. Hordinsky said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The use of JAK inhibitors is not the only notable development in the treatment of hair loss; light-based options show potential as well, according to Maria Hordinsky, MD.

“Although the precise mechanism remains unclear, it has been postulated that photobiomodulation acts through oxidative metabolism and transcription factor stimulation,” Dr. Hordinsky said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The use of JAK inhibitors is not the only notable development in the treatment of hair loss; light-based options show potential as well, according to Maria Hordinsky, MD.

“Although the precise mechanism remains unclear, it has been postulated that photobiomodulation acts through oxidative metabolism and transcription factor stimulation,” Dr. Hordinsky said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

When evaluating lumps and bumps in infants, categorizing them can help determine whether they need immediate attention, said James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia, Pennsylvania.

“Divide ‘birthmarks’ based on appearance, “then decide when to worry,” he said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

For example, Spitz nevi occur in patients younger than 20 years, most often on the face and lower extremities, but most are benign, Dr. Treat said. However, he recommends a biopsy if the patient is pubertal or older, or if the lesions are larger than 8 mm, amelanotic, or show asymmetry, ulceration, or excessive growth.

By contrast, neurocutaneous melanosis is a rare but serious skin condition that occurs in children and can be fatal if it progresses to melanoma, he pointed out. The condition involves the migration of melanocytes into the spinal canal and cerebrospinal fluid during development. Symptoms may include headache, seizures, and paralysis, and clinicians should keep them in mind when seeing children with melanocytic nevi, he noted. The highest risk for melanoma transformation is increased for individuals with more than 20 congenital moles, and “the second-highest risk is having a giant nevus lying overtop of the midline spine or scalp,” he said.

In some cases, yellow or tan lesions in children are benign and will resolve on their own, Dr. Treat said.

Juvenile xanthogranuloma (JXG), characterized by yellow-brown asymptomatic papules and nodules, develops most often within the first year of life, but the lesions usually resolve spontaneously by school age, he added.

Mastocytosis, localized collections of mast cells, presents as yellow/tan lesions that develop within the first 2 years of life. The condition can be systemic; patients may experience flushing and diarrhea because of localized release of histamines, and those with a history of weight loss, easy bruising or bleeding, hepatosplenomegaly, or lymphadenopathy may have systemic disease, Dr. Treat explained.

Subcutaneous fat necrosis can present within the first 2 weeks of life as firm, red-purple tender nodules that may be disturbing to parents. These lesions are most likely to appear on the cheeks, arms, back, and thighs, and are related to hypoxia or trauma, he added. The lesions usually resolve spontaneously within a period of weeks to months, although they may heal with some atrophy and scarring, he said. Subcutaneous fat necrosis is associated with hypercalcemia, so “it is important to check frequently, as hypercalcemia can occur weeks after the nodules resolve,” he commented.

Dr. Treat disclosed serving as a consultant to Procter & Gamble. SDEF and this news organization are owned by Frontline Medical Communications.

When evaluating lumps and bumps in infants, categorizing them can help determine whether they need immediate attention, said James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia, Pennsylvania.

“Divide ‘birthmarks’ based on appearance, “then decide when to worry,” he said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

For example, Spitz nevi occur in patients younger than 20 years, most often on the face and lower extremities, but most are benign, Dr. Treat said. However, he recommends a biopsy if the patient is pubertal or older, or if the lesions are larger than 8 mm, amelanotic, or show asymmetry, ulceration, or excessive growth.

By contrast, neurocutaneous melanosis is a rare but serious skin condition that occurs in children and can be fatal if it progresses to melanoma, he pointed out. The condition involves the migration of melanocytes into the spinal canal and cerebrospinal fluid during development. Symptoms may include headache, seizures, and paralysis, and clinicians should keep them in mind when seeing children with melanocytic nevi, he noted. The highest risk for melanoma transformation is increased for individuals with more than 20 congenital moles, and “the second-highest risk is having a giant nevus lying overtop of the midline spine or scalp,” he said.

In some cases, yellow or tan lesions in children are benign and will resolve on their own, Dr. Treat said.

Juvenile xanthogranuloma (JXG), characterized by yellow-brown asymptomatic papules and nodules, develops most often within the first year of life, but the lesions usually resolve spontaneously by school age, he added.

Mastocytosis, localized collections of mast cells, presents as yellow/tan lesions that develop within the first 2 years of life. The condition can be systemic; patients may experience flushing and diarrhea because of localized release of histamines, and those with a history of weight loss, easy bruising or bleeding, hepatosplenomegaly, or lymphadenopathy may have systemic disease, Dr. Treat explained.

Subcutaneous fat necrosis can present within the first 2 weeks of life as firm, red-purple tender nodules that may be disturbing to parents. These lesions are most likely to appear on the cheeks, arms, back, and thighs, and are related to hypoxia or trauma, he added. The lesions usually resolve spontaneously within a period of weeks to months, although they may heal with some atrophy and scarring, he said. Subcutaneous fat necrosis is associated with hypercalcemia, so “it is important to check frequently, as hypercalcemia can occur weeks after the nodules resolve,” he commented.

Dr. Treat disclosed serving as a consultant to Procter & Gamble. SDEF and this news organization are owned by Frontline Medical Communications.

When evaluating lumps and bumps in infants, categorizing them can help determine whether they need immediate attention, said James R. Treat, MD, a pediatric dermatologist at Children’s Hospital of Philadelphia, Pennsylvania.

“Divide ‘birthmarks’ based on appearance, “then decide when to worry,” he said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

For example, Spitz nevi occur in patients younger than 20 years, most often on the face and lower extremities, but most are benign, Dr. Treat said. However, he recommends a biopsy if the patient is pubertal or older, or if the lesions are larger than 8 mm, amelanotic, or show asymmetry, ulceration, or excessive growth.

By contrast, neurocutaneous melanosis is a rare but serious skin condition that occurs in children and can be fatal if it progresses to melanoma, he pointed out. The condition involves the migration of melanocytes into the spinal canal and cerebrospinal fluid during development. Symptoms may include headache, seizures, and paralysis, and clinicians should keep them in mind when seeing children with melanocytic nevi, he noted. The highest risk for melanoma transformation is increased for individuals with more than 20 congenital moles, and “the second-highest risk is having a giant nevus lying overtop of the midline spine or scalp,” he said.

In some cases, yellow or tan lesions in children are benign and will resolve on their own, Dr. Treat said.

Juvenile xanthogranuloma (JXG), characterized by yellow-brown asymptomatic papules and nodules, develops most often within the first year of life, but the lesions usually resolve spontaneously by school age, he added.

Mastocytosis, localized collections of mast cells, presents as yellow/tan lesions that develop within the first 2 years of life. The condition can be systemic; patients may experience flushing and diarrhea because of localized release of histamines, and those with a history of weight loss, easy bruising or bleeding, hepatosplenomegaly, or lymphadenopathy may have systemic disease, Dr. Treat explained.

Subcutaneous fat necrosis can present within the first 2 weeks of life as firm, red-purple tender nodules that may be disturbing to parents. These lesions are most likely to appear on the cheeks, arms, back, and thighs, and are related to hypoxia or trauma, he added. The lesions usually resolve spontaneously within a period of weeks to months, although they may heal with some atrophy and scarring, he said. Subcutaneous fat necrosis is associated with hypercalcemia, so “it is important to check frequently, as hypercalcemia can occur weeks after the nodules resolve,” he commented.

Dr. Treat disclosed serving as a consultant to Procter & Gamble. SDEF and this news organization are owned by Frontline Medical Communications.

Categorizing hair loss in children depends on many factors, but it is important to rule out an infectious etiology as early as possible, according to Sheila Fallon Friedlander, MD.

“What can Tinea capitis look like? Anything,” she said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

Although T. capitis most often presents in children aged 3-7 years as a pattern of localized hair loss, often with scaling, sometimes with nodules, other possibilities include pustules, boggy masses, and diffuse hair loss, said Dr. Friedlander, professor of pediatrics and dermatology at the University of California, San Diego.

Sometimes the hair loss may be so subtle that families come in complaining of “dandruff” rather than hair loss, she noted. Evaluating the patient for the presence of cervical or occipital lymph nodes is crucial; big nodes are usually a tip-off that infection is present.

The optimal treatment plan for T. capitis depends on the source, Dr. Friedlander explained. If M. canis is the cause, “griseofulvin is the drug of choice,” along with a twice-weekly sporicidal shampoo, she said.

Other treatment options include terbinafine, itraconazole, and fluconazole, and each have their pros and cons, she said. Terbinafine – which persists for months in the skin, nails, and hair – is the least expensive, and is her first choice for infections caused by T. tonsurans.

Itraconazole is available as a liquid, but costs more, causes diarrhea, and comes with a boxed warning about the potential for cardiac complications; fluconazole is the most expensive, but may be used in infants, she added.

Other high-risk groups for T. capitis include female caretakers of high-risk individuals, such as “grandma”; wrestlers; and Buddhist monks, she said. “Short hair, sharing combs, and unclean barbers” contributed to a documented increased risk of T. capitis according to a recently published study of 60 Buddhist monks whose average age was 11.6 years, she added. (Pediatr Dermatol. 2017 May;34[3]:371-3).

Dr. Friedlander had no relevant financial conflicts to disclose.

SDEF and this news organization are owned by Frontline Medical Communications.

Categorizing hair loss in children depends on many factors, but it is important to rule out an infectious etiology as early as possible, according to Sheila Fallon Friedlander, MD.

“What can Tinea capitis look like? Anything,” she said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

Although T. capitis most often presents in children aged 3-7 years as a pattern of localized hair loss, often with scaling, sometimes with nodules, other possibilities include pustules, boggy masses, and diffuse hair loss, said Dr. Friedlander, professor of pediatrics and dermatology at the University of California, San Diego.

Sometimes the hair loss may be so subtle that families come in complaining of “dandruff” rather than hair loss, she noted. Evaluating the patient for the presence of cervical or occipital lymph nodes is crucial; big nodes are usually a tip-off that infection is present.

The optimal treatment plan for T. capitis depends on the source, Dr. Friedlander explained. If M. canis is the cause, “griseofulvin is the drug of choice,” along with a twice-weekly sporicidal shampoo, she said.

Other treatment options include terbinafine, itraconazole, and fluconazole, and each have their pros and cons, she said. Terbinafine – which persists for months in the skin, nails, and hair – is the least expensive, and is her first choice for infections caused by T. tonsurans.

Itraconazole is available as a liquid, but costs more, causes diarrhea, and comes with a boxed warning about the potential for cardiac complications; fluconazole is the most expensive, but may be used in infants, she added.

Other high-risk groups for T. capitis include female caretakers of high-risk individuals, such as “grandma”; wrestlers; and Buddhist monks, she said. “Short hair, sharing combs, and unclean barbers” contributed to a documented increased risk of T. capitis according to a recently published study of 60 Buddhist monks whose average age was 11.6 years, she added. (Pediatr Dermatol. 2017 May;34[3]:371-3).

Dr. Friedlander had no relevant financial conflicts to disclose.

SDEF and this news organization are owned by Frontline Medical Communications.

Categorizing hair loss in children depends on many factors, but it is important to rule out an infectious etiology as early as possible, according to Sheila Fallon Friedlander, MD.

“What can Tinea capitis look like? Anything,” she said in a presentation at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

Although T. capitis most often presents in children aged 3-7 years as a pattern of localized hair loss, often with scaling, sometimes with nodules, other possibilities include pustules, boggy masses, and diffuse hair loss, said Dr. Friedlander, professor of pediatrics and dermatology at the University of California, San Diego.

Sometimes the hair loss may be so subtle that families come in complaining of “dandruff” rather than hair loss, she noted. Evaluating the patient for the presence of cervical or occipital lymph nodes is crucial; big nodes are usually a tip-off that infection is present.

The optimal treatment plan for T. capitis depends on the source, Dr. Friedlander explained. If M. canis is the cause, “griseofulvin is the drug of choice,” along with a twice-weekly sporicidal shampoo, she said.

Other treatment options include terbinafine, itraconazole, and fluconazole, and each have their pros and cons, she said. Terbinafine – which persists for months in the skin, nails, and hair – is the least expensive, and is her first choice for infections caused by T. tonsurans.

Itraconazole is available as a liquid, but costs more, causes diarrhea, and comes with a boxed warning about the potential for cardiac complications; fluconazole is the most expensive, but may be used in infants, she added.

Other high-risk groups for T. capitis include female caretakers of high-risk individuals, such as “grandma”; wrestlers; and Buddhist monks, she said. “Short hair, sharing combs, and unclean barbers” contributed to a documented increased risk of T. capitis according to a recently published study of 60 Buddhist monks whose average age was 11.6 years, she added. (Pediatr Dermatol. 2017 May;34[3]:371-3).

Dr. Friedlander had no relevant financial conflicts to disclose.

SDEF and this news organization are owned by Frontline Medical Communications.

Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.

In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.

“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.

Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.

More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.

Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.

Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”

In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.

Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.

“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.

Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.

SDEF and this news organization are owned by Frontline Medical Communications.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.

In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.

“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.

Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.

More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.

Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.

Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”

In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.

Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.

“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.

Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.

SDEF and this news organization are owned by Frontline Medical Communications.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

Adult women with acne need to be taken more seriously and offered more treatment options, according to Hilary Baldwin, MD, clinical associate professor of dermatology at Robert Wood Johnson Medical School, New Brunswick, N.J.

In a presentation on adult acne in women at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar, Dr. Baldwin said that while acne in females typically peaks between ages 14 and 17 years, many women in the United States are experiencing adult-onset acne that can persist late into adulthood. “The adult female has been ignored in the past, when we’ve been concentrating primarily on teenagers with acne,” Dr. Baldwin explained in an interview. Women are the second most commonly population affected by acne, with an estimated prevalence in up to 50% of women in their 20s, 30% of women in their 30s, and 25% in their 40s, she added.

“It may ‘just be’ acne at 16 when it’s going to go away at 17, but it’s not ‘just acne’ in a 23-year-old who’s going to have it until menopause,” she said.

Three subtypes of acne have been described in adult women: Persistent acne, a continuation of acne from adolescence to adulthood; late onset acne, the development of acne in patients after age 25 years; and relapsing acne, the return of acne later in life in a patient who had acne as an adolescent. In adults, about 80% of acne is the persistent type.

More study is needed to determine the prevalence of the relapsing subtype, which is not well described in the literature, Dr. Baldwin noted.

Two types of acne in adult women have been described, and they may have different responses to treatment, she said. The “U zone” form is characterized by inflammatory papules and nodules – and no comedones – that primarily affect the lower third of the face, jawline, and neck, typically sparing the back and shoulders, she said. Conversely, the diffuse form is characterized by numerous comedones and inflammatory lesions, which may produce scarring.

Dr. Baldwin said that acne can have a greater impact on women than on adolescents, with a greater impact on quality of life – and emotional effects that are “similar to patients with psoriasis.”

In a survey of 128 women with acne who were asked about what they expect from their dermatologists, 56% said they felt examination with their dermatologists was too quick, and 44% said that they felt that their skin was not looked at meticulously enough. And almost half said that the discussion of different treatment options was not detailed enough, and was too short.

Most dermatologists can evaluate the severity of a patient’s acne without bringing out a magnifying glass, but for the sake of the patient’s trust, taking the time to check “more meticulously” may help the patient mentally and physically, she said. Taking this time, as well as involving patients in treatment decisions, may also improve treatment adherence, she added.

“You are more likely, if you made a decision or helped to make a decision ... to use the product,” Dr. Baldwin said about working with patients.

Dr. Baldwin disclosed serving as a speaker, adviser, and/or investigator for Allergan, Bayer, BioPharmX, Dermira, Encore, La Roche-Posay, Mayne, Novan, Johnson & Johnson, Sun, Valeant, and Galderma.

SDEF and this news organization are owned by Frontline Medical Communications.

ezimmerman@frontlinemedcom.com

On Twitter @eaztweets

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.

Clinicians faced with baffling contact dermatitis patients should expand their view of potential causes to include metals anywhere in the body, according to Jennifer H. Perryman, MD, of the Greeley Skin Clinic in Fort Collins, Colo.

For example, metal from orthopedic implants can cause contact dermatitis, Dr. Perryman said at Skin Disease Education Foundation’s Women’s & Pediatric Dermatology Seminar.

The cutaneous complications of metal implants generally are eczematous, but they can be urticarial and vasculitic as well, with symptoms either generalized or localized. Dr. Perryman explained. Noncutaneous complications from contact dermatitis associated with the metal include chronic joint pain, and a loosening and dysfunction of the device.

It is a case of “chicken or the egg: Metal allergy causes device failure, or device failure causes metal allergy,” Dr. Perryman said.

Dental implants also can be unforeseen causes of contact dermatitis, she noted. The bone cement used in some implants may contain a variety of potential irritants such as methyl methacrylate, N,N-dimethyl-p-toluidine (DPT), benzoyl peroxide, gentamicin, and hydroquinone.

Metal allergy in the mouth most often presents as a reaction resembling oral lichen planus, with lesions that are reticular, atrophic, erosive, or plaque-like. These lesions usually erupt next to the implant, she said. Some patients also experience burning mouth syndrome from amalgam tattoos. However, some patients who test positive for metal allergies in general have developed a tolerance for dental implants as a result of having worn braces in the past.

Metal eyelid weights implanted to treat lagophthalmos are another rare, but potential allergen to consider, said Dr. Perryman. These weights often are made of gold, and Dr. Perryman cited a study in which four patients with gold eyelid weights experienced inflammatory reactions. Patch testing revealed gold sodium thiosulfate as the cause of their allergic contact dermatitis (Dermatitis. 2008 May-Jun;19[3]:148-53). Other options for these patients include platinum weights, hyaluronic acid, ointment, and taping, she said.

Dr. Perryman had no financial conflicts to disclose. SDEF and this news organization are owned by Frontline Medical Communications.