#dermJC Transcript

Healthcare social media transcript of the #dermJC hashtag.
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Steven Chen @DrStevenTChen
Steven here from MGH/Boston. No COI. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
Big take home for this JAMA article is that kids get allergic contact dermatitis even if they have atopic dermatitis which wasn't thought to be the case until recently #dermjc
Ade Adamson, MD MPP @AdeAdamson
Hailing from Austin, Texas with no COI #dermjc
David Terrano @david_terrano
Dr. Terrano, Dermpath, Listening in from AZ no COI #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
Because AD is Th2 and ACD is Th1, people didn't think they can co-exist. Some early studies showed dampening of STRONG allergens in mice which are not applicable to humans. #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: Jeff Yu here, MGH, no COI (other than the fact that I <3 Contact Derm) #dermjc
Dermatology Journal Club @DermatologyJC
RT @DrStevenTChen: Steven here from MGH/Boston. No COI. #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: Big take home for this JAMA article is that kids get allergic contact dermatitis even if they have atopic dermatitis which was…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: Because AD is Th2 and ACD is Th1, people didn't think they can co-exist. Some early studies showed dampening of STRONG allerge…
Elizabeth Ahlstrom @ElizabethAhlstr
Elizabeth, dermatology PA-C from Georgia. No COI. #dermjc
Dermatology Journal Club @DermatologyJC
RT @ElizabethAhlstr: Elizabeth, dermatology PA-C from Georgia. No COI. #dermjc
Dermatology Journal Club @DermatologyJC
RT @david_terrano: Dr. Terrano, Dermpath, Listening in from AZ no COI #dermjc
Dermatology Journal Club @DermatologyJC
RT @AdeAdamson: Hailing from Austin, Texas with no COI #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
This studies shows that children with atopic dermatitis in particular are more sensitized to weaker allergens such as cocamidopropyl betaine, lanolin, parthenolide, and tixocortol-21-pivalate than non-atopic kids which makes sense due to exposure patterns. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
Probably the major drawback in this study is the heterogenous reporting from derm providers not all trained in patch testing from across the country. Reading may be different and determination of relevance may also be different. #dermjc
David Harker, MD @HarkerDavid
@DermatologyJC David, UTSW derm resident. Dallas. No COI. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@jiadeyu Do you think that the skin barrier issues in AD cause patients to be more likely to have exposure to antigens and develop ACD? #dermjc
Dermatology Journal Club @DermatologyJC
RT @HarkerDavid: @DermatologyJC David, UTSW derm resident. Dallas. No COI. #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: This studies shows that children with atopic dermatitis in particular are more sensitized to weaker allergens such as cocamido…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: Probably the major drawback in this study is the heterogenous reporting from derm providers not all trained in patch testing f…
Steven Chen @DrStevenTChen
@RoxanaDaneshjou @jiadeyu Agree!!! I remember being taught that people with AD can get sensitized to allergens, which is why we have to careful with the skin care recs we make. #dermjc
Dermatology Journal Club @DermatologyJC
RT @RoxanaDaneshjou: @jiadeyu Do you think that the skin barrier issues in AD cause patients to be more likely to have exposure to antigens…
Dermatology Journal Club @DermatologyJC
RT @DrStevenTChen: @RoxanaDaneshjou @jiadeyu Agree!!! I remember being taught that people with AD can get sensitized to allergens, which is…
JiaDe (Jeff) Yu, MD @patchtestjeff
There is such a thing called the lanolin paradox where lanolin containing products, eg Aquaphor or Eucerin, can cause ACD on already inflamed skin (stasis derm) but not intact skin. #dermjc https://t.co/vtWKuiO4K4
Goran Micevic @gmicevic
Hi, I am Goran, a resident at Yale. No COI. What was striking to me while reading the article was lack of high quality data in literature on the prevalence of ACD in patients with AD #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@gmicevic Absolutely! This study is great because it really highlights that AD patients get ACD. Patch testing should always be considered when patients with AD are recalcitrant to therapy. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
This stuck out to me, particularly since a lot of the products people use For atopic dermatitis such as aquaphor contains lanolin. #dermjc https://t.co/xhEhqKwFK1
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: @gmicevic Absolutely! This study is great because it really highlights that AD patients get ACD. Patch testing should always b…
JiaDe (Jeff) Yu, MD @patchtestjeff
My rule of thumb for patch testing patient selection is 1) new onset atopic in someone who is not a young child 2) unusual locations for eczema 3) not getting better with conventional treatment 4) before initiation of systemics #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
Oh haha, just saw this tweet @jiadeyu #dermjc https://t.co/uqPOm9xtPr
Dermatology Journal Club @DermatologyJC
RT @gmicevic: Hi, I am Goran, a resident at Yale. No COI. What was striking to me while reading the article was lack of high quality data i…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: There is such a thing called the lanolin paradox where lanolin containing products, eg Aquaphor or Eucerin, can cause ACD on a…
Dermatology Journal Club @DermatologyJC
RT @RoxanaDaneshjou: This stuck out to me, particularly since a lot of the products people use For atopic dermatitis such as aquaphor conta…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: My rule of thumb for patch testing patient selection is 1) new onset atopic in someone who is not a young child 2) unusual loc…
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou Parthenolide is a marker for plant allergy (most common plant group the Compositae) and also significantly higher in atopics. This includes chamomile, daisies, etc often found in "natural" "calming" "organic" products parents will gravitate towards at whole foods. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: @RoxanaDaneshjou Parthenolide is a marker for plant allergy (most common plant group the Compositae) and also significantly hi…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @RoxanaDaneshjou Parthenolide is a marker for plant allergy (most common plant group the Compositae) and also significantly hi…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@jiadeyu - do you think allergic contact dermatitis is underdiagnosed? #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
And how do you think this data corresponds to our adult patients? #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
@jiadeyu @RoxanaDaneshjou I was wondering about this. There seems to be trend toward using plant and food-based ingredients in skin care products. (I’ve seen recent cases of probable ACD to products containing lavender, aloe, chamomile, etc. I don’t remember seeing that as much 10 years ago. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou Without a doubt, especially in pediatric populations. I'm curious to know who here patch tests children routinely in clinical practice? #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@ElizabethAhlstr @jiadeyu It’s interesting that people say they want to use “natural products”. I have to often explain that you can be quite allergic to natural skin products! #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou The same. Adults with ACD are underdiagnosed due to access issues. Most centers don't have a patch testing dermatologists. Some will just use the TRUE test which misses 40% of relevant positive reactions! #dermjc @ACDS_Dermatitis
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou In a typical week, I see 7-8 adults for patch testing and probably 0-1 child. It's a good week when I see 2. #pediatricians #pediatricdermatologists just don't think about it as much because the prevalence of AD is so high. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@jiadeyu I did peds continuity as a first year. We would refer to patch testing in atopic dermatitis patients who were not responding to appropriate topical steroid courses. #dermjc
Dermatology Journal Club @DermatologyJC
RT @ElizabethAhlstr: @jiadeyu @RoxanaDaneshjou I was wondering about this. There seems to be trend toward using plant and food-based ingred…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @RoxanaDaneshjou The same. Adults with ACD are underdiagnosed due to access issues. Most centers don't have a patch testing de…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @RoxanaDaneshjou In a typical week, I see 7-8 adults for patch testing and probably 0-1 child. It's a good week when I see 2.…
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @RoxanaDaneshjou Yes! The more it's used the more likely the development of ACD. Case in point..the allergen methylisothiazolinone. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@DrStevenTChen @jiadeyu @DrStevenTChen I also feel like I see a lot of allergic contact dermatitis in the hospital. Are your internal medicine residents thinking about it? #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @RoxanaDaneshjou 10 years ago, MI was used in low concentrations with methylchloroisothiazolinone in a mix called MCI/MI. MCI fell out of favor due to allergenicity. They started using higher concentration of MI. MI allergy started to skyrocket in the late 2000s. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @RoxanaDaneshjou However, MI allergy is missed 33% of the time when testing with the TRUE test which still uses MCI/MI as the marker. #dermjc @ACDS_Dermatitis
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @RoxanaDaneshjou Yes! The more it's used the more likely the development of ACD. Case in point..the allergen…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @RoxanaDaneshjou 10 years ago, MI was used in low concentrations with methylchloroisothiazolinone in a mix ca…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @RoxanaDaneshjou However, MI allergy is missed 33% of the time when testing with the TRUE test which still us…
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou @ElizabethAhlstr I tell people poison ivy is natural, mold is natural, and cyanide is natural. You don't rub that all over yourself! #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
@RoxanaDaneshjou I suspect it could be even worse for adults, especially those with hand dermatitis. A lifetime of AD would seem to predispose a person to exposure to allergens via an inefficient skin barrier. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
Some really important clinical pearls are being shared by @jiadeyu during the #dermjc chat. Follow the hashtag #dermjc or the account @DermatologyJC to follow along.
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @RoxanaDaneshjou @ElizabethAhlstr I tell people poison ivy is natural, mold is natural, and cyanide is natural. You don't rub…
Dermatology Journal Club @DermatologyJC
RT @ElizabethAhlstr: @RoxanaDaneshjou I suspect it could be even worse for adults, especially those with hand dermatitis. A lifetime of AD…
Steven Chen @DrStevenTChen
@RoxanaDaneshjou @jiadeyu I think there’s usually a high level of suspicion when they see something geometric, and adhesives from dressings, ekg leads, eg are easier to identify. However, I find that a lot of people miss it when it’s surgical prep/OR stuff. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @RoxanaDaneshjou Great point. Hairdressers, dental technicians, nurses, doctors, etc all highly prone to developing allergic contact dermatitis. #dermjc
Dermatology Journal Club @DermatologyJC
RT @DrStevenTChen: @RoxanaDaneshjou @jiadeyu I think there’s usually a high level of suspicion when they see something geometric, and adhes…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @RoxanaDaneshjou Great point. Hairdressers, dental technicians, nurses, doctors, etc all highly prone to deve…
JiaDe (Jeff) Yu, MD @patchtestjeff
@DrStevenTChen @RoxanaDaneshjou One patient had her breast surgery opened and redone 3 times due to concerns for infection. Patch tested her, she was allergic to dermabond #dermjc https://t.co/n5273MGjnZ
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
This is why having dermatologists involved is important. #dermjc #medtwitter
Leo Shmuylovich, MD PhD @leoshmu
@jiadeyu #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @DrStevenTChen @RoxanaDaneshjou One patient had her breast surgery opened and redone 3 times due to concerns for infection. Pa…
Dermatology Journal Club @DermatologyJC
RT @RoxanaDaneshjou: This is why having dermatologists involved is important. #dermjc #medtwitter https://t.co/a0zelwan2D
Elizabeth Ahlstrom @ElizabethAhlstr
@jiadeyu @RoxanaDaneshjou @ACDS_Dermatitis Interesting. It does seem like allergens follow the trend of whatever preservative is most popular in the industry. I remember when we were scouring labels for DDM Hydantoin and then MCI/MI. What is it about preservatives that makes them such good sensitizers? #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@leoshmu A lot of the elucidation was done in mice models from what I understand to strong allergens such as DNCB. These were very strong Th1. Human allergens like fragrance mix, cocamidopropyl, etc, may have some Th2 activation. #dermjc
Dermatology Journal Club @DermatologyJC
RT @ElizabethAhlstr: @jiadeyu @RoxanaDaneshjou @ACDS_Dermatitis Interesting. It does seem like allergens follow the trend of whatever prese…
David Harker, MD @HarkerDavid
@DrStevenTChen @RoxanaDaneshjou @jiadeyu Had a patient on consults recently that I’m pretty sure had contact allergy to the soap provided in the rooms. #dermjc https://t.co/pIChUWjjzp
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @HarkerDavid: @DrStevenTChen @RoxanaDaneshjou @jiadeyu Had a patient on consults recently that I’m pretty sure had contact allergy to th…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: @leoshmu A lot of the elucidation was done in mice models from what I understand to strong allergens such as DNCB. These were…
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @RoxanaDaneshjou @ACDS_Dermatitis Commonly used? Not sure! We don't know what makes something potentially allergenic and somethings not (maybe someone does out there). But don't forget, nickel, cobalt, fragrances, and topical antibiotics are also in top 10 from the NACDG @DermatitisJrnl #dermjc
David Harker, MD @HarkerDavid
@RoxanaDaneshjou yeah our pedi derm strongly discourages anything with lanolin #dermjc
David Harker, MD @HarkerDavid
RT @jiadeyu: @RoxanaDaneshjou @ElizabethAhlstr I tell people poison ivy is natural, mold is natural, and cyanide is natural. You don't rub…
JiaDe (Jeff) Yu, MD @patchtestjeff
@HarkerDavid @DrStevenTChen @RoxanaDaneshjou Probably fragrance. Don't believe in the myth of parabens. Low likelihood of acd (though not unreported) and would prefer over many others (formaldehyde releasers, MCI, MI) #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @HarkerDavid @DrStevenTChen @RoxanaDaneshjou Probably fragrance. Don't believe in the myth of parabens. Low likelihood of acd…
David Harker, MD @HarkerDavid
@jiadeyu @DrStevenTChen @RoxanaDaneshjou Yeah I think it was fragrance. Scented soaps had caused him to “break out” in the past. #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
RT @jiadeyu: @HarkerDavid @DrStevenTChen @RoxanaDaneshjou Probably fragrance. Don't believe in the myth of parabens. Low likelihood of acd…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
@HarkerDavid @jiadeyu @DrStevenTChen Makes me wonder why we are giving soaps with fragrance in the hospital. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
Any final thoughts, comments, or questions on the @JAMADerm article? #dermjc
David Harker, MD @HarkerDavid
@RoxanaDaneshjou @jiadeyu @DrStevenTChen ping @Parkland #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@RoxanaDaneshjou @HarkerDavid @DrStevenTChen Oh you know why. Cheap and can get in bulk. #dermjc
Leo Shmuylovich, MD PhD @leoshmu
While not found significant in the study, I always wonder about formaldehyde for some pedi patients with prominent facial rashes that have ACD concern - i think cigarette smoke releases formaldehyde #dermjc
Leo Shmuylovich, MD PhD @leoshmu
So even when kids nuzzle into a shirt that isn't formaldehyde releasing, the smoking makes it effectively a formaldehyde releasing shirt #dermjc anyone seen this is a real thing?
JiaDe (Jeff) Yu, MD @patchtestjeff
@leoshmu Yes. I've seen 1 person with facial dermatitis to formaldehyde in his cigarette smoke. Haven't seen it in kids but interesting point. More kids need to be patch tested! #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
@jiadeyu @JAMADerm Referral to a patch testing clinic is a huge challenge in many rural areas. Is there anything commercially available that’s better than True Test for patch testing kids? #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
New rage is E-cigarettes which has nickel in the mouth piece. #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: Any final thoughts, comments, or questions on the @JAMADerm article? #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @leoshmu: While not found significant in the study, I always wonder about formaldehyde for some pedi patients with prominent facial rash…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @leoshmu: So even when kids nuzzle into a shirt that isn't formaldehyde releasing, the smoking makes it effectively a formaldehyde relea…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: @leoshmu Yes. I've seen 1 person with facial dermatitis to formaldehyde in his cigarette smoke. Haven't seen it in kids but in…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @ElizabethAhlstr: @jiadeyu @JAMADerm Referral to a patch testing clinic is a huge challenge in many rural areas. Is there anything comme…
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: New rage is E-cigarettes which has nickel in the mouth piece. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @JAMADerm Unfortunately there is nothing commercially available beyond TRUE test. We did publish a pediatric patch test series last year we recommend using on all kids 6 and up and potentially younger if appropriate #dermjc https://t.co/iNvTjJVS1P @DermatitisJrnl
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: Any final thoughts, comments, or questions on the @JAMADerm article? #dermjc
Dermatology Journal Club @DermatologyJC
RT @leoshmu: While not found significant in the study, I always wonder about formaldehyde for some pedi patients with prominent facial rash…
Dermatology Journal Club @DermatologyJC
RT @leoshmu: So even when kids nuzzle into a shirt that isn't formaldehyde releasing, the smoking makes it effectively a formaldehyde relea…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @leoshmu Yes. I've seen 1 person with facial dermatitis to formaldehyde in his cigarette smoke. Haven't seen it in kids but in…
Dermatology Journal Club @DermatologyJC
RT @ElizabethAhlstr: @jiadeyu @JAMADerm Referral to a patch testing clinic is a huge challenge in many rural areas. Is there anything comme…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: New rage is E-cigarettes which has nickel in the mouth piece. #dermjc
JiaDe (Jeff) Yu, MD @patchtestjeff
@ElizabethAhlstr @JAMADerm Best resource to find a patch tester is the ACDS website https://t.co/00dRYfqO2J @ACDS_Dermatitis to find someone near you! #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
@jiadeyu I did not know this! #dermjc
Elizabeth Ahlstrom @ElizabethAhlstr
RT @jiadeyu: @ElizabethAhlstr @JAMADerm Unfortunately there is nothing commercially available beyond TRUE test. We did publish a pediatric…
Steven Chen @DrStevenTChen
@RoxanaDaneshjou @jiadeyu I'd add that I find it amusing how many people blame the sheets in the hospital when it's a morbilliform drug rash. #dermjc
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @JAMADerm Unfortunately there is nothing commercially available beyond TRUE test. We did publish a pediatric…
Dermatology Journal Club @DermatologyJC
RT @jiadeyu: @ElizabethAhlstr @JAMADerm Best resource to find a patch tester is the ACDS website https://t.co/00dRYfqO2J @ACDS_Dermatitis t…
Dermatology Journal Club @DermatologyJC
@leoshmu @jiadeyu @ElizabethAhlstr @JAMADerm @DermatitisJrnl #dermjc
Dermatology Journal Club @DermatologyJC
Thank you @jiadeyu for teaching us about allergic contact dermatitis for this #dermjc. I hope people enjoyed it!!
David Terrano @david_terrano
RT @jiadeyu: @ElizabethAhlstr @JAMADerm Best resource to find a patch tester is the ACDS website https://t.co/00dRYfqO2J @ACDS_Dermatitis t…
JiaDe (Jeff) Yu, MD @patchtestjeff
@DermatologyJC Thanks for having me on! Please follow me on twitter for #contactdermcase of the week and other #contactderm pearls! @ACDS_Dermatitis @nationaleczema #dermjc
Roxana Daneshjou, MD/PhD @RoxanaDaneshjou
RT @jiadeyu: @ElizabethAhlstr @JAMADerm Best resource to find a patch tester is the ACDS website https://t.co/00dRYfqO2J @ACDS_Dermatitis t…
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