Oral TXA is a safe and efficacious treatment for refractory melasma. It should be considered in cases that are unresponsive to topical hydroquinone and combination topical therapy over a period of approximately 12 weeks and without contraindications to oral TXA.

Background Allergic contact dermatitis (ACD) is an increasingly common diagnosis in children. The objectives of this study were to review our experience with ACD in children in tertiary settings, to ascertain the spectrum of allergens in this population and to subsequently propose the first Australian Paediatric Baseline Series for patch testing. Methods We conducted a retrospective analysis of patch test data from 1993 to 2017 from two tertiary referral patch‐testing centres in Melbourne, Victoria. Results A total of 511 children were patch tested during the study period. Of these, 58.3% (298/511) of children tested had a positive patch test, and 65.1% (194/298, or 38.0% of the total) had a relevant positive patch test. The most common relevant patch test reactions were fragrance mix, methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) and methylisothiazolinone (MI), Myroxylon pereirae, nickel sulphate, and colophonium. Conclusion Allergic contact dermatitis is not uncommon in children, and patch testing should be considered in children with suspected ACD or with recalcitrant atopic dermatitis. Based on our experience over 25 years, we propose the first Australian Paediatric Baseline Series.

Background Patch testing is the gold standard for the diagnosis of allergic contact dermatitis (ACD). The Australian Baseline Series (ABS) was formulated by our group to include the 60 most common and relevant allergens in our patient population. The aim of this study was to assess the efficacy of testing with the Australian Baseline Series in order to diagnose allergic contact dermatitis. Methods We conducted a retrospective study of 964 patients with ACD diagnosed at our centre from 1 January 2012 to 31 December 2018. Patients with at least one relevant positive reaction were stratified into three groups: i) reactions only to allergens in the Australian Baseline Series; ii) reactions to allergens in the Australian Baseline Series and to additional allergens; and iii) reactions only to allergens not present in the Australian Baseline Series. Results The Australian Baseline Series alone was successful in identifying the cause of allergic contact dermatitis in 63.4% (611/964) of patients. In 23.0% (222/964), the Australian Baseline Series detected at least one relevant allergen, but there were relevant allergens outside of the Australian Baseline Series as well. In 13.6% (141/964), no relevant allergens were detected in the Australian Baseline Series, but allergens were detected in additional series or by testing patients’ own products. The most frequently occurring allergens not included in the Australian Baseline Series were citral, ammonium persulfate, geraniol, oakmoss absolute and chlorhexidine diacetate. Conclusions The Australian Baseline Series is an adequate screening tool for identifying patients with ACD. Nevertheless, females should be additionally routinely tested with the fragrance series. Patients with suspected occupationally related dermatitis should always be tested with additional allergens and own products.

Chlorhexidine is a widely used and effective antiseptic agent. Although skin contact is usually well tolerated, it may cause both immediate and delayed hypersensitivity reactions. We report a case of immediate hypersensitivity to chlorhexidine causing both skin and respiratory symptoms following occupational exposure to chlorhexidine in a health-care worker.

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