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Öğe Artificial nail modelling systems in healthcare workers: An emerging risk of contact sensitization to a well-known occupational allergen in an alternative way(Wiley, 2024) Keskinkaya, Zeynep; Mermutlu, Selda Isik; Kaya, Ozge; Cakir, HaileBackground: Artificial nail modelling systems (ANMS) pose a significant risk for nail stylists and their clients regarding acrylate sensitization, which might jeopardize the use of acrylate-containing medical devices. Objectives: To evaluate the frequency of artificial nail practices among female healthcare workers (HCWs) compared with controls and assess ANMS-related side effects. Methods: In this comparative, cross-sectional, single-centre study, a face-to-face interview with 200 female HCWs and 200 age-matched female dermatology patients (controls) was conducted regarding the use of ANMS between March and November 2023. Results: Among 400 participants (median age: 25), 85 (21.3%) have applied ANMS at least once. The prevalence of ANMS application was significantly higher in HCWs (n = 54/200, 27%) compared with controls (n = 31/200, 15.5%) (p < 0.05). Long-lasting nail polish was the most commonly preferred technique (n = 82/85, 96.5%). ANMS were mainly performed in nail studios by nail stylists (n = 79/85, 92.9%), while three participants were using home kits. Nail brittleness was the most frequently reported side effect (n = 19/85, 22.4%). No case of allergic contact dermatitis (ACD) was detected. Conclusions: The popularity of ANMS among young female HCWs is growing. This striking trend might further put these individuals not only at risk of medical device-related adverse events but also occupational ACD.Öğe Clinical and dermoscopic patterns of acquired melanocytic nevi in children and adolescents: a cross-sectional study from Turkey(Elsevier Espana S.L.U, 2025) Keskinkaya, Zeynep; Kaya, Özge; Işık Mermutlu, Selda; Garipcan Karaemir, Hilay; Oğuz Kılıç, SevilayBackground: Childhood and adolescence are the most active periods for nevi development, which provide insights into nevogenesis. Objectives: To evaluate the clinical and dermoscopic characteristics of acquired melanocytic nevi in Turkish children (aged ? 10-years) and adolescents (aged > 10-years) regarding demographic, constitutional, and environmental factors. Methods: A cross-sectional study on participants aged < 18-years examined for acquired melanocytic nevi between January and June 2023. Results: One hundred participants (female: male ratio = 1:1; median age: 10) were assessed. The median nevi number was significantly higher in adolescents than in children (6 vs. 4; p < 0.05). The upper extremities (n = 68) and trunk (n = 67) were the most commonly involved anatomical regions. Females had a significantly higher nevi rate on the upper extremities than males (80% vs. 56%; p < 0.05). The trunk was involved slightly more frequently in males (76% vs. 58%; p = 0.06). The globular pattern rate was higher in children than in adolescents (70.6% vs. 42.9%; p < 0.05), whereas a striking increase was observed in the reticular pattern from childhood (2%) to adolescence (14.3%) (p < 0.05). The globular pattern was the major dermoscopic pattern in all anatomical locations except lower extremities where the homogeneous pattern prevailed. Sunscreen use had no impact on the nevi number or dermoscopic pattern. Study limitations: Limited number of participants. Conclusions: The age and anatomical site were the most relevant factors influencing the number and dermoscopic patterns of nevi. The gender-related distribution pattern of nevi, without any effect of sunscreen use on either nevus count or dermoscopic pattern, suggests a genetic predisposition. © 2024 Sociedade Brasileira de DermatologiaÖğe Clinico-Epidemiological Profile of Immunocompetent Patients Diagnosed with Herpes Zoster: A Single-Center Retrospective Cohort Study from Sinop(Zonguldak Bülent Ecevit Üniversitesi, 2023) Keskinkaya, Zeynep; Ismayilov, Ayna Sariyeva; Güçlü, Özge AydınAim: Herpes zoster (HZ) mainly occurs in immunocompetent individuals, even though immunosuppression is a well-known risk factor. The aim of this study was to evaluate the demographic and clinical features of immunocompetent HZ patients and HZ-related complications with a special focus on possible contributing factors. Material and Methods: This single-center, retrospective cohort study included 98 patients with no known immunosuppressive condition out of 103 patients diagnosed with HZ between September 2019 and August 2020. The patients were evaluated in terms of age, sex, medical history, clinical features, triggering factors, seasonality, complications, and neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammation. Results: Ninetyeight immunocompetent patients (male:female ratio=1.1:1) were diagnosed with HZ, with a median age of 59 years (age range: 5-88). Thoracic dermatome was the leading dermatome (n=45). Trigeminal nerve was involved in 11 patients, eight of them presenting with ophthalmic HZ. HZ attacks were mainly detected in summer, while ophthalmic HZ cases were exclusively diagnosed during fall and winter. Two patients developed ophthalmic HZ following trauma. Eleven patients experienced postherpetic neuralgia (PHN) during follow-up with a male predominance (p=0.009). A higher mean NLR value was detected in PHN patients, although it was not statistically significant (p=0.136). Conclusion: The findings of our study are compatible with the current literature regarding the main presentation pattern of HZ as unilateral thoracic dermatome involvement and the complications such as PHN and ophthalmic HZ occurring in a subgroup of patients. The high HZ incidence rate in our series is likely due to the high median age of the population in our region. The summer peak of HZ cases further supports the seasonal variability due to the ultraviolet effect, whereas mechanical trauma is another possible triggering factor. The predictive value of NLR for PHN should be evaluated in further studiesÖğe COVID-19 Among Patients with Psoriasis: A Single-Center Retrospective Cross-Sectional Study(Doc Design Informatics Co Ltd, 2023) Kaya, Ozge; Keskinkaya, Zeynep; Mermutlu, Selda Isik; Kilic, Sevilay Oguz; Cakir, HaileObjective: Psoriasis patients may have been affected by COVID-19 differently than the nor-mal population due to using different types of treatments, including immunosuppressive agents and biological therapies, the probability of lower effectiveness, and different side effects of the vaccines. This study aimed to evaluate the epidemiologic and clinical features of COVID-19 and the effect of the psoriasis treatment on it. Materials and Methods: Psoriasis patients followed up in our clinic between March 2020 and July 2022 were evaluated in terms of clinicodemographic characteristics, treatment methods, and COVID-19 vaccination status and compared regarding COVID-19 history. Results: A total of 110 patients (female:male ratio=1:1.2) with a mean age of 45.6 +/- 14.3 years were evaluated. Thirty patients (27.2%) developed COVID-19 during psoriasis treatment. Unvaccinated patients had COVID-19 (6/11, 55%) more frequently than vaccinated ones (24/99, 24%), but it was not statistically significant (p=0.067). Although patients who re-ceived biological therapy were also more frequently infected with SARS-CoV-2 than pa-tients who received other types of therapies (18/53 [34%] versus 12/57 [21%], respectively), the difference was again not statistically significant. A patient with hypertension using acitretin was hospitalized for pulmonary involvement because of COVID-19. No exacerba-tion of psoriasis was observed in patients who developed COVID-19, while psoriasis flares occurred following COVID-19 mRNA vaccination in two patients. Conclusion: Patients with psoriasis should get vaccinated against COVID-19, as vaccination prevents the disease and does not result in serious side effects. Although using biological agents for the treatment of psoriasis could be related to a higher risk of getting COVID-19, these agents do not increase the risk of severe COVID-19. Therefore, they may be beneficial in reducing the risk of both psoriasis exacerbations and severe COVID-19 due to the cy-tokine storm among patients using biological for psoriasis. However, large-scale and con-trolled studies are needed to support our conclusions.Öğe EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF HIDRADENITIS SUPPURATIVA PATIENTS: 10-YEAR EXPERIENCE FROM A SINGLE TERTIARY CENTER(Istanbul Univ, Fac Medicine, Publ Off, 2023) Mermutlu, Selda Isik; Keskinkaya, ZeynepObjective: To investigate the clinico-epidemiological profile of hidradenitis suppurativa (HS) patients.Material and Method: In this retrospective cross-sectional single tertiary center study, the HS patients diagnosed and/or followed up between 2012-2022 were evaluated regarding demographic features, clinical findings, associated comorbidities, therapies initiated for HS and their outcomes.Results: Of 101 HS patients (male:female ratio=1.7:1), 23.3% (n=20) had a history of early-onset disease (<18 years). The majority had no family history of HS (82.7%, n=62). The patients were classified according to disease severity as Hurley I (33.7%, n=34), Hurley II (46.5%, n=47) and Hurley III (19.8%, n=20). Patients with early-onset disease and Hurley III HS had a significantly higher number of affected anatomical sites (p<0.05). The axillary region was the most commonly involved anatomical site (n=78), followed by the inguinal (n=57) and gluteal regions (n=23). Sixty-four patients (74.4%) were overweight/obese, and 84.5% (n=71) were current or ex-smokers. Acne vulgaris was the main dermatological comorbidity associated with HS (n=23). Pilonidal sinus disease was present in 25.5% (n=25). Patients with Hurley III HS presented with significantly higher rates of pilonidal sinus disease and involvement of the gluteal and perianal regions (p<0.05). Nineteen patients were diagnosed with metabolic syndrome. Systemic antibiotics were the most frequently prescribed first-line agents. Hidradenitis Suppurativa Clinical Response (HiSCR) achievement was observed most frequently with biologics, particularly adalimumab.Conclusion: In line with the current literature, HS poses an increased disease burden with its associated comorbidities. The predominance of the male sex and the anatomical involvement patterns seen in our HS patients are compatible with previously reported Turkish series. Pilonidal sinus disease and involvement of the gluteal and perianal regions in HS patients are important signs of severe disease, also highlighted in recent studies. The biologic agents seem to be the best therapeutic option for achieving HiSCR, especially in severe HS forms.Öğe Evaluation of Clinical and Laboratory Findings of COVID-19 Patients with Dermatological Involvements: A Single-Center Retrospective Cross-Sectional Study(Bilimsel Tip Yayinevi, 2023) Kaya, Ozge; Alkan, Sevil; Keskinkaya, Zeynep; Cinpolat, Yasemin Havva; Mermutlu, Selda Isik; Kilic, Sevilay OguzIntroduction: Cutaneous manifestations of the coronavirus disease-2019 (COVID-19) are increasingly reported, with their incidence and pathophysiological mechanisms yet to be clarified. The aim of this study was to evaluate COVID-19 patients presenting with dermatological involvement.Materials and Methods: COVID-19 patients with dermatological involvements followed up in a single tertiary center between August 2020 and August 2021 were assessed in terms of demographic characteristics, clinical and laboratory findings, and treatment methods.Results: A total of 65 patients (female:male ratio= 0.4:1, mean age= 59.7 +/- 18.2 years) were evaluated. The dermatological involvements due to COVID-19 were maculopapular rash (n= 49, 75.4%), urticaria (n= 9, 13.8%), herpes zoster (HZ) (n= 6, 9.2%), and pernio (n= 1, 1.5%). In COVID-19 patients with dermatological involvements pulmonary involvement rate was 96.9%. The most common accompanying symptoms were anosmia (n= 47, 72.3%) and ageusia (n= 43, 66.2%), The mean time between the first COVID-19 symptom and the onset of dermatological involvement was 3.3 +/- 1.2 days, and the mean time to regression of the lesions was 3.2 +/- 1.8 days.Conclusion: Anosmia, ageusia, and pulmonary involvement were common findings especially in patients with maculopapular rash and HZ, probably due to increased inflammation and cytokine storm. The assessment of anosmia and ageusia, especially in patients presenting with maculopapular rash and HZ, may help early recognition of COVID-19 cases. In addition, it should be predicted that individuals with this combination may have a higher risk of pulmonary involvement and disease severity and necessary precautions should be taken during the early stages.Öğe Evaluation of Serum Tumor Necrosis Factor-alpha-Induced Adipose-Associated Protein (TIARP/STEAP4) Level and Its Association with Disease Activity in Patients with Psoriasis: ASingle-Center Prospective Comparative Study(Galenos Publ House, 2024) Kaya, Ozge; Keskinkaya, Zeynep; Sehitoglu, Muserref Hilal; Mermutlu, Selda Isik; Kilic, Sevilay OguzAim: Tumor necrosis factor-alpha (TNF-alpha)-induced adipose-associated protein (TIARP/STEAP4) is a protective metalloreductase against oxidative stress that is induced by various proinflammatory cytokines, including TNF-alpha and interleukin-17. This study aimed to evaluate whether STEAP4 is elevated in patients with psoriasis and whether it is associated with disease activity. Materials and Methods: In this prospective cross-sectional single-center study, serum STEAP4 levels measured by the ELISA method in serum samples collected from psoriasis patients and healthy individuals. The association between STEAP4 levels and demographic characteristics and clinical findings in patients with psoriasis was further evaluated. Results: Forty-one psoriasis patients with a female: male ratio of 1:1 and a median age of 44 years and 40 controls were included in the study. The median STEAP4 level of the patients with psoriasis (9.25) was significantly higher than that of the control group (1.04) (P < 0.001). Although STEAP4 levels did not differ significantly in patients with psoriasis regarding sex, joint, and nail involvement, no significant correlation was found with age, age at disease onset, disease duration, and severity. Conclusion: The high levels of STEAP4 detected in patients with psoriasis might reflect its anti-inflammatory effects on Th-1 and Th-17 responses and on neutrophil and macrophage infiltration. On the other hand, a possible genetic variation or defect at the receptor level for STEAP4 in patients with psoriasis might hamper an adequate anti-inflammatory effect and lead to increased STEAP4 expression as a compensation mechanism. The present study not only indicates that STEAP4 might play a role in the pathogenesis of psoriasis but also suggests potential implications for its role in treatment and follow-up, which offers a promising direction for further investigation.Öğe Küçük Çocuk ve Ebeveynlerinin Güneşten Korunma Yöntemleri: Türkiye’den Karşılaştırmalı Kesitsel bir Çalışma(Bursa Uludağ University, 2024) Keskinkaya, Zeynep; Mermutlu, Selda Işık; Kaya, Özge; Taşkıran, AyşegülBu çalışma; küçük çocuklar ve ebeveynleri tarafından kullanılan güneşten korunma yöntemlerinin sıklığını araştırmayı ve ebeveynlerin bilgi ve davranışlarının çocuklarının güneşten korunma uygulamaları üzerindeki olası etkisini değerlendirmeyi amaçlamaktadır. Haziran ve Aralık 2023 tarihleri arasında 3-5 yaş aralığındaki çocukların ebeveynlerine; güneşten korunma konusunda farkındalık testi ve güneşten korunma yöntemleri, bu yöntemleri kullanmayı teşvik eden ve engelleyen faktörlere ilişkin anket uygulanmıştır. Yüz kırk ebeveyn [ortanca yaş: 35 (27-49), kadın:erkek=113:27] çalışmaya dahil edildi. Hekimlerden tavsiye alan ebeveynlerin ortanca farkındalık puanı [14,0 (0-19)] almayanlara kıyasla [12,0 (1-18)] daha yüksekti (p [EN] This study aimed to investigate the frequency of sun protection measures used by young children and their parents and evaluate the possible effect of parental knowledge and behavior on their children’s sun safety practices. A sun safety awareness test and a self-reported questionnaire survey regarding sun protection strategies, reasons and barriers for using these methods were conducted on parents of children aged 3-5 years between June and December 2023. One hundred fourty parents [median age: 35 (27-49), female:male=113:27] were included. Parents who sought advice from their physicians [14.0 (0-19)] had a higher median awareness score than those who did not [12.0 (1-18)] (pÖğe Long-term dupilumab therapy in Netherton syndrome with severe atopic manifestations: Case report and review of the literature(John Wiley and Sons Inc, 2023) Özkaya, Esen; Günay, Muhammed Burak; Babuna Kobaner, Goncagül; Keskinkaya, Zeynep; Gökalp, Mehmet OnurWe herein present a unique patient of Netherton syndrome (NS) with ichthyosis linearis circumflexa (ILC) lesions associated with severe atopic manifestations since infancy, showing different responses of atopic and ILC lesions to a 2-year dupilumab therapy. The atopic eczematous lesions and pruritus healed remarkably, dramatically improving the patient's quality of life, whilst the scalp hair showed a clinical and light microscopic improvement. The additional recovery in axillary/pubic/extremity hair growth, sweating and nail growth in the presented case was not previously reported in NS patients treated with dupilumab. However, dupilumab had no therapeutic effect on ILC lesions which were not pruritic and showed a treatment-independent wax and waned course.Öğe Long-Term Omalizumab Therapy in Patients with Chronic Spontaneous Urticaria: Does it Increase the Risk of COVID-19?(Mattioli 1885, 2023) Kaya, Ozge; Keskinkaya, Zeynep; Mermutlu, Selda Isik; Kilic, Sevilay Oguz; Ozturk, SevgiIntroduction: Based on the existing literature, omalizumab (OMZ) is considered a safe treatment modality in chronic spontaneous urticaria (CSU) during the coronavirus disease 19 (COVID-19) era. Objectives: The aim of this study is to evaluate the effects of OMZ on CSU patients regarding COVID-19 infection. Methods: In this retrospective study, files of CSU patients using OMZ during the COVID-19 pandemic were reviewed in terms of demographic features, medical history including COVID-19 vaccination status, clinical characteristics, pretreatment laboratory parameters, duration, and dosing regimen of OMZ treatment. Patients with a history of COVID-19 infection while on OMZ therapy and patients without COVID-19 history were compared with respect to these parameters. The urticaria activations following COVID-19 infection or vaccination were also recorded. Results: Sixty-eight patients with CSU (female:male ratio = 1.8:1; mean age = 47.2 +/- 15.1 years) continued to receive OMZ treatment. The median duration of OMZ treatment was 12 months (range: 6-60). Twelve patients (17.6%) were diagnosed with COVID-19 showing no exacerbation in urticaria. The duration of OMZ treatment was significantly higher in the group with COVID-19 infection history compared to patients with no history of COVID-19 (P = 0.01). Among 51 patients (75%) vaccinated against COVID-19, urticaria activation occurred in 4 patients without any recurrence following booster vaccinations. Conclusions: Considering the likelihood of increased COVID-19 infection risk in the setting of long-term OMZ in CSU patients, the duration of OMZ therapy might be kept at a minimum, or a temporary interruption of the treatment period might be preferred, particularly in high-risk patients regarding COVID-19.Öğe Need for new strategies to improve the recall and avoidance rates of contact allergens: A retrospective cohort study from Turkey(John Wiley and Sons Inc, 2024) Özkaya, Esen; Keskinkaya, ZeynepBackground: Previous studies reported a low-to-moderate benefit from patch testing regarding allergen recall and avoidance.Objectives: To determine the allergen recall and avoidance rates of patients with allergic contact dermatitis (ACD) in Turkey.Methods: This was a retrospective cohort study based on a phone questionnaire of 465 patients diagnosed with ACD from major allergen groups, that is, metals, preservatives, rubber, fragrances (ubiquitous allergens) and hair dye/black henna, topical drug and resins (nonubiquitous allergens), at our tertiary referral centre between 1996 and 2018.Results: Among 176 responders, allergen groups were remembered better (53.4%) than the individual allergens (36.9%). Age <40 years and keeping the allergy pass had a significantly positive impact on the recall rate of methylchloroisothiazolinone/methylisothiazolinone and nickel, particularly non-occupational nickel allergy from metal jewellery in females, respectively. Exacerbations of ACD (56.3%) were mainly due to reexposures to ubiquitous allergens. 42.9% of patients with occupational ACD changed or quit their job, most of them being construction workers and hairdressers, showing a high share (83.3%) of benefit.Conclusions: The overall rates of allergen recall and avoidance were moderate. New strategies are needed to improve the recall and avoidance rates of contact allergens, such as increased use of allergy pass, smartphone applications and legal precautions.Öğe Predicting the Speed of Response to Omalizumab in Chronic Spontaneous Urticaria(Karger, 2024) Keskinkaya, Zeynep; Kaya, Ozge; Mermutlu, Selda Isik; Ogretmen, ZerrinIntroduction: Two distinct chronic spontaneous urticaria (CSU) endotypes, IgE-mediated autoallergic and IgG-mediated autoimmune, were defined based on the response patterns to omalizumab. However, the coexistence of IgE and IgG autoantibodies in a subset of patients might complicate the prediction of the treatment outcomes. This study aimed to evaluate the effectiveness and safety of omalizumab in CSU patients, focusing on the factors predicting the response patterns. Methods: This was a retrospective cross-sectional single-center study investigating CSU patients treated with omalizumab for at least 6 months between September 2015 and February 2023. Patients were evaluated regarding demographics, clinical findings, baseline laboratory parameters, treatment outcomes, and side effects. Early and late responders were defined depending on the time for response, within or after 3 months, respectively. Results: Among 82 patients, 75 (91.5%) responded to omalizumab during the first 6 months, classified as early (n = 51) and late responders (n = 24). The IgG anti-thyroid peroxidase (anti-TPO)/total IgE ratio was an independent predictor for determining the speed of response (p < 0.05). Of 29 patients who discontinued omalizumab, 19 (65.5%) experienced relapse with a good response to retreatment (n = 18/19, 94.7%). Early responders relapsed more frequently than late responders (77.3% vs. 28.6%) (p < 0.05). Only mild side effects were observed in a minority of patients (n = 8/82, 9.8%). Conclusion: Omalizumab is an effective and safe treatment in CSU. The IgG anti-TPO/total IgE ratio seems a valuable tool to predict the early and late responders, the former having a higher possibility of relapse upon drug withdrawal.Öğe The role of salusins and interleukin 12 family in the rosacea pathogenesis(Wolters Kluwer Medknow Publications, 2023) Demir, Nesrin; Kaya, Ozge; Keskinkaya, Zeynep; Oguz Kilic, Sevilay; Ekinci, Alper; Karadeli, UmitAim: Salusins and recently discovered interleukin (IL)-12 family members (IL-35 and IL-39) have been investigated in various disorders associated with chronic inflammation. The aim of this study was to evaluate the roles of salusin-alpha (alpha), salusin-beta (beta), IL-35, and IL-39 in the pathogenesis of rosacea. Methods: This study is a single-center, prospective case-control study performed in a tertiary healthcare institution. Salusin-alpha, salusin-beta, IL-35, and IL-39 were analyzed by enzyme-linked immunosorbent assay method from venous blood of 50 rosacea patients who did not receive any treatment and 50 age-matched healthy controls, and the test results were compared between the two groups as statistically. Results: Patients in the rosacea group (female:male ratio = 1.9:1; median age: 56 years) had significantly higher mean salusin-alpha, IL-35, and IL-39 levels compared with the control group (female:male ratio = 2.1:1; median age: 41 years). There was no statistically significant difference between the two groups in terms of salusin-beta levels. Conclusion: The increased vascularity and Th1-mediated inflammation might be possible explanations for the elevated salusin-alpha and IL-39 levels in rosacea patients. On the other hand, the higher mean IL-35 level detected in the same group was an unexpected finding due to the immunosuppressive effect of the cytokine. Recently, targeted therapies have become popular in many inflammatory diseases. In this context, salusins, IL-35, and IL-39 seem to be possible molecules that could be modified for therapeutic reasons in the future in the treatment of rosacea.Öğe Tobramycin and antiglaucoma agents as increasing culprits of periorbital allergic contact dermatitis from topical ophthalmic medications: A 24-year study from Turkey(John Wiley and Sons Inc, 2023) Özkaya, Esen; Keskinkaya, Zeynep; Babuna Kobaner, GoncagülBackground: Allergic contact dermatitis (ACD) from topical ophthalmic medications (TOMs) poses an additional disease burden to patients who already suffer from eye problems. Objectives: To investigate the epidemiological/clinical profile of patients with periorbital ACD from TOMs in Turkey. Patients and Methods: This was a retrospective, cross-sectional, single tertiary centre study based on files of 75 patch tested patients with suspected periorbital ACD from TOMs among a total of 2801 consecutively patch tested patients with suspected ACD of any origin between 1996 and 2019. Results: Periorbital ACD was diagnosed in 25 of 75 (33.3%) patients (female:male = 1.8:1; age range: 6–85 years) with suspected ACD from TOMs showing an overall prevalence of 0.9% (25/2801) among the whole patch test population. Atopy was not present. Tobramycin-containing TOMs were the most frequent culprits, followed by antiglaucoma preparations. Their frequency increased, whereas no new cases of neomycin-induced ACD were observed after 2011. Positivities with thimerosal were of unknown clinical relevance, while benzalkonium chloride (BAC) caused ACD in two patients. The diagnosis would be missed in each 20% of patients without performing day (D) 4 and D7 readings and strip-patch testing. Ten culprits were identified only by testing with patients' own TOMs in eight (32%) patients. Conclusions: Aminoglycosides, particularly tobramycin, were the leading cause of ACD from TOMs. The frequency of ACD from tobramycin and antiglaucoma medications increased after 2011. BAC was a rare but important allergen. Additional D4 and D7 readings, strip-patch testing, and testing with patients' own TOMs seem essential when patch testing with eye medications.
