DERMATITIS

Sep
2013
Vol. 32. No. 3

Introduction

We are pleased to present this issue of Seminars in Cutaneous Medicine and Surgery devoted entirely to dermatitis, one of the most common diagnoses faced by clinicians in dermatology practice. We have selected noted experts to review where we stand clinically in the understanding and management of several of these diseases.
 
The initial article by Caitlin Harskamp and April Armstrong examines the complex and intriguing immunology of atopic dermatitis. The rapid evolution in our understanding of the basic science of this disease is now translating into the discovery of targeted therapeutic agents. Similar to psoriasis, where bench-work efforts have directly connected to the bedside over the last 2 decades, atopic dermatitis looks to be the next dermatologic disease to enter the exciting biologic treatment arena.
 
With the consumer demand for more “natural” personal care products, there are an increasing number of botanicals that are being used in topical medicaments and cosmetics. Although the general belief is that these botanicals are “safer” for use, there have been many popular extracts reported to cause allergic contact dermatitis. Alexander Jack, Patricia Norris, and Frances Storrs address this emerging area of allergic contact dermatitis to plant extracts in cosmetics with an excellent review of a number of botanicals and the clinical presentations for botanical extract contact dermatitis.
 
Hand dermatitis is one of the most common entities encountered in dermatology and its impact on quality of life is significant. Spring Golden and Tatyana Shaw present a comprehensive review of hand dermatitis, focusing on the various subtypes and treatment options for each. The diagnosis of the subtype of hand dermatitis is a clinical one. Through the use of excellent clinical images and tables, this article helps the clinician to more accurately diagnosis and best manage the many patients afflicted with hand dermatitis.
 
Mark Davis, Sara Hylwa and Eve Allen present the basics of patch testing for allergic contact dermatitis. Allergic contact dermatitis can be the sole diagnosis or complicate any number of dermatoses; therefore it should be considered when evaluating a patient with dermatitis or other chronic dermatoses. This article details the logistics of patch testing, the importance of patient education and interpretation of results, and addresses some of the controversies within this area.
 
Laurel Morton and Tania Phillips next address the area of chronic venous insufficiency and focus on the challenging cutaneous manifestations of venous eczema and lipodermatosclerosis. After reviewing the clinical presentation, pathogenesis and pathology, they use a thorough review of the literature combined with their own personal extensive experience to offer therapeutic guidance and management.
 
Ari Goldminz and Alice Gottlieb masterfully explore the puzzling group of diseases known as granulomatous dermatitides. This efficient and comprehensive 3-part review sheds light on the presentation, pathology and treatment of granuloma annulare, interstitial granulomatous dermatitis and annular elastolytic giant cell granuloma.
 
It has been a pleasure to work with this incredibly talented group of authors. We thank them for their valuable contributions and hope that you will find this issue as enlightening and useful as we do.

Hand Dermatitis: Review of Clinical Features and Treatment Options

Spring Golden, MD | Tatyana Shaw, MD

Hand dermatitis affects a significant portion of the population and can be caused by a variety of endogenous factors (ie, atopy) as well as occupational and environmental exposures. It is often a chronic problem with high costs to individuals, employers, and society. This review discusses subtypes of hand dermatitis based on their clinical features and pathogenesis. It also offers an approach to treatment.
Semin Cutan Med Surg 32:147-157 © 2013 Frontline Medical Communications

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Noninfectious Granulomatous Dermatitides: A Review of 8 Disorders (Part 1 of 3)

Alice B. Gottlieb, PhD | Ari M. Goldminz, MD

In this review we focus on 2 of the noninfectious granulomatous dermatitides, granuloma annulare and interstitial granulomatous dermatitis (the remaining 6 will be discussed in Parts 2 and 3), with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and no randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebocontrolled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
Semin Cutan Med Surg 32:177-182 © 2013 Frontline Medical Communications

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Noninfectious Granulomatous Dermatitides: A Review of 8 Disorders (Part 2 of 3)

Alice B. Gottlieb, PhD | Ari M. Goldminz, MD

In this review we focus on 3 of the non-infectious granulomatous dermatitides, annular elastolytic giant cell granuloma, necrobiosis lipoidica, and necrobiosis xanthogranuloma, with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and very few randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebo-controlled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
Semin Cutan Med Surg 32:e1-e6 © 2013 Frontline Medical Communications

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Noninfectious Granulomatous Dermatitides: A Review of 8 Disorders (Part 3 of 3)

Alice B. Gottlieb, PhD | Ari M. Goldminz, MD

In this review we focus on 3 of the non-infectious granulomatous dermatitides, interstitial granulomatous drug reaction, rheumatoid nodules, and cutaneous sarcoidosis, with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and very few randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebo-controlled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
Semin Cutan Med Surg 32:e7-e11 © 2013 Frontline Medical Communications

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Immunology of Atopic Dermatitis: Novel Insights into Mechanisms and Immunomodulatory Therapies

April W Armstrong, MD, MPH | Caitlin T. Harskamp, BA

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin condition that is associated with immune dysregulation and epidermal barrier dysfunction. The imbalance of the Th2 and Th1 pathways and their associated cytokines in AD presents as one facet of the pathogenic mechanisms. Changes in the T-cell populations and the associated cytokines during the acute and chronic phases of AD can cause variations in disease presentations and treatment responses. Continued discoveries in the immunopathogenesis of AD provide optimism for the development of efficacious therapeutic agents. Novel immunomodulatory
therapies include apremilast, dupilumab, IL-37, omalizumab, rituximab, mepolizumab, infliximab, allergen-specific immunotherapy, Mycobacterium vaccae, and leflunomide. These agents serve as examples of how modulation in immunopathogenesis of AD can lead to therapeutic discoveries.
Semin Cutan Med Surg 32:132-139 © 2013 Frontline Medical Communications

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