A current or past history of atopic dermatitis (AD) is more often associated with contact hypersensitivity to ingredients found in emollients and topical medications, and with sensitivity to multiple allergens, than those with no history of AD, which may predispose individuals with the condition to the development of allergic contact dermatitis (ACD), according to the results of a single-center, retrospective chart review that were published in the Journal of the American Academy of Dermatology.
The investigators sought to establish the predictors of ACD and relevant allergens in patients with AD, recognizing that AD is linked to skin barrier disruption, immune system dysregulation, and application of topical medications and emollients. A total of 502 patients aged at least 18 years were patch-tested to an expanded allergen series from 2014 to 2017.
Overall, 21.5% (108 of 502) of participants had current AD and 21.7% (109 of 502) had past AD. Patients with current AD vs those without current AD exhibited similar proportions of any positive (+/++/+++: 80 [74.1%] vs 254 [64.5%], respectively; Chi-square, P =.06), stronger (++/+++: 34 [31.5%] vs 102 [25.9%], respectively; P =.25), and irritant (56 [51.9%] vs 188 [47.7%], respectively; P =.45) reactions. Likewise, patients with past AD vs those with no AD exhibited similar proportions of any positive (+/++/+++: 72 [65.1%] vs 137 [65.6%], respectively; P =.94), stronger (++/+++: 28 [25.7%] vs 59 [28.2%], respectively; P =.63), and irritant (50 [45.9%] v 102 [48.8%], respectively; P =.62) reactions.
Participants with current AD vs without current AD reported significantly higher rates of positive patch test reactions to ingredients in their personal care products or topical medications, including bacitracin (7.4% vs 3.0%, respectively; P =.04), fragrance mix II (5.6% vs 2.0%, respectively; P =.04), lanolin (4.6% vs 1.3%, respectively; P =.03), cinnamal (3.7% vs 0.8%, respectively; P =.02), chlorhexidine (3.7% vs 0.2%, respectively; P =.01), tixocortol pivalate (3.7% vs 0.8%, respectively; P =.02), and budesonide (1.8% vs 0.0%, respectively; P =.01).
Those with past AD compared with those with no history of AD exhibited significantly higher rates of positive patch test reaction to cinnamal (2.8% vs 0.0%, respectively; P =.04), cyanoacrylate (2.8% vs 0.0%, respectively; P =.04), quaternium-15 (2.8% vs 0.0%, respectively; P =.04), and lanolin (3.7% vs 0.5%, respectively; P =.04). Further, polysensitization was reported significantly more often in patients with AD vs those without AD (35 [32.4%] vs 75 [19.0%] respectively; P =.01).
A major limitation of the current study was the fact that it was conducted at a single academic center. For that reason, the results may not be generalizable to all adults with AD. Additional studies are underway to determine the effect of contact allergen avoidance on the severity and clinical course of AD.
Rastogi S, Patel KR, Singam V, Silverberg JI. Allergic contact dermatitis to personal care products and topical medications in adults with atopic dermatitis [published online July 24, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.07.017