Allergic contact dermatitis

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doi:doi: 10.12788/jfp.0678

Dx Across the Skin Color Spectrum

Allergic contact dermatitis

J Fam Pract. 2023 October;72(8):350-352,355 | doi: 10.12788/jfp.0678

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References

1. Mowad CM, Anderson B, Scheinman P, et al. Allergic contact dermatitis: patient diagnosis and evaluation. J Am Acad Dermatol. 2016;74:1029-1040. doi: 10.1016/j.jaad.2015.02.1139

2. Usatine RP, Riojas M. Diagnosis and management of contact dermatitis. Am Fam Physician. 2010;82:249-255.

3. Bertoli MJ, Schwartz RA, Janniger CK. Autoeczematization: a strange id reaction of the skin. Cutis. 2021;108:163-166. doi: 10.12788/cutis.0342

4. Johansen JD, Bonefeld CM, Schwensen JFB, et al. Novel insights into contact dermatitis. J Allergy Clin Immunol. 2022;149:1162-1171. doi: 10.1016/j.jaci.2022.02.002

5. Karagounis TK, Cohen DE. Occupational hand dermatitis. Curr Allergy Asthma Rep. 2023;23:201-212. doi: 10.1007/s11882-023- 01070-5

6. Cvetkovski RS, Rothman KJ, Olsen J, et al. Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema. Br J Dermatol. 2005;152:93-98. doi: 10.1111/j.1365-2133.2005.06415.x

7. Owen JL, Vakharia PP, Silverberg JI. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018;19:293-302. doi: 10.1007/s40257-017-0340-7

8. Brites GS, Ferreira I, Sebastião AI, et al. Allergic contact dermatitis: from pathophysiology to development of new preventive strategies. Pharmacol Res. 2020;162:105282. doi: 10.1016/ j.phrs.2020.105282

9. Nielsen NH, Menne T. The relationship between IgE‐mediatedand cell‐mediated hypersensitivities in an unselected Danish population: the Glostrup Allergy Study, Denmark. Br J Dermatol. 1996;134:669-672. doi: 10.1111/j.1365-2133.1996.tb06967.x

10. Alinaghi F, Bennike NH, Egeberg A, et al. Prevalence of contact allergy in the general population: a systematic review and meta‐analysis. Contact Dermatitis. 2019;80:77-85. doi: 10.1111/cod.13119

11. DeLeo VA, Alexis A, Warshaw EM, et al. The association of race/ ethnicity and patch test results: North American Contact Dermatitis Group, 1998-2006. Dermatitis. 2016;27:288-292. doi: 10.1097/ DER.0000000000000220

12. Warshaw EM, Schlarbaum JP, Silverberg JI, et al. Contact dermatitis to personal care products is increasing (but different!) in males and females: North American Contact Dermatitis Group data, 1996-2016. J Am Acad Dermatol. 2021;85:1446-1455. doi: 10.1016/j jaad.2020.10.003

13. Dickel H, Taylor JS, Evey P, et al. Comparison of patch test results with a standard series among white and black racial groups. Am J Contact Dermatol. 2001;12:77-82. doi: 10.1053/ajcd.2001.20110

14. DeLeo VA, Taylor SC, Belsito DV, et al. The effect of race and ethnicity on patch test results. J Am Acad Dermatol. 2002;46(2 suppl):S107-S112. doi: 10.1067/mjd.2002.120792

15. Scott I, Atwater AR, Reeder M. Update on contact dermatitis and patch testing in patients with skin of color. Cutis. 2021;108:10-12. doi: 10.12788/cutis.0292

16. Tamazian S, Oboite M, Treat JR. Patch testing in skin of color: a brief report. Pediatr Dermatol. 2021;38:952-953. doi: 10.1111/ pde.14578

17. Litchman G, Nair PA, Atwater AR, et al. Contact dermatitis. Stat- Pearls [Internet]. Updated February 9, 2023. Accessed September 25, 2023. www.ncbi.nlm.nih.gov/books/NBK459230/

18. Alexis AF, Callender VD, Baldwin HE, et al. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: review and clinical practice experience. J Am Acad Dermatol. 2019;80:1722-1729. doi: 10.1016/j.jaad.2018.08.049

19. Rodriguez-Homs LG, Liu B, Green CL, et al. Duration of dermatitis before patch test appointment is associated with distance to clinic and county poverty rate. Dermatitis. 2020;31:259-264. doi: 10.1097/DER.0000000000000581

20. Foschi CM, Tam I, Schalock PC, et al. Patch testing results in skin of color: a retrospective review from the Massachusetts General Hospital contact dermatitis clinic. J Am Acad Dermatol. 2022;87:452-454. doi: 10.1016/j.jaad.2021.09.022

21. Qian MF, Li S, Honari G, et al. Sociodemographic disparities in patch testing for commercially insured patients with dermatitis: a retrospective analysis of administrative claims data. J Am Acad Dermatol. 2022;87:1411-1413. doi: 10.1016/j.jaad.2022.08.041

22. Young K, Collis RW, Sheinbein D, et al. Retrospective review of pediatric patch testing results in skin of color. J Am Acad Dermatol. 2023;88:953-954. doi: 10.1016/j.jaad.2022.11.031

23. Kadyk DL, Hall S, Belsito DV. Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation. Dermatitis. 2004;15:117-124.

The underrepresentation of patients with skin of color (SOC) in educational materials as well as socioeconomic health disparities may contribute to the lower rates of diagnosis, patch testing, and treatment of ACD in this patient population.

Epidemiology

An ACD prevalence of 15.2% was reported in a study of 793 Danish patients who underwent skin prick and patch testing.⁹ Alinaghi et al¹⁰ conducted a meta-analysis of 20,107 patients across 28 studies who were patch tested to determine the prevalence of ACD in the general population. The researchers concluded that 20.1% (95% CI, 16.8%-23.7%) of the general population experienced ACD. They analyzed 22 studies to determine the prevalence of ACD based on specific geographic area, including 18,709 individuals from Europe with a prevalence of 19.5% (95% CI, 15.8%-23.4%), 1639 individuals from North America with a prevalence of 20.6% (95% CI, 9.2%-35.2%), and 2 studies from China (no other studies from Asia found) with a prevalence of 20.6% (95% CI, 17.4%-23.9%). Researchers did not find data from studies conducted in Africa or South America.¹⁰

The current available epidemiologic data on ACD are not representative of SOC populations. DeLeo et al¹¹ looked at patch test reaction patterns in association with race and ethnicity in a large sample size (N = 19,457); 92.9% of these patients were White and only 7.1% were Black. Large-scale, inclusive studies are needed, which can only be achieved with increased suspicion for ACD and increased access to patch testing.

ACD is more common in women, with nickel being the most frequently identified allergen (FIGURE A).¹⁰ Personal care products often are linked to ACD (FIGURE B). An analysis of data from the North American Contact Dermatitis Group revealed that the top 5 personal care product allergens were methylisothiazolinone (a preservative), fragrance mix I, balsam of Peru, quaternium-15 (a preservative), and paraphenylenediamine (PPD; a common component of hair dye) (FIGURE C).¹²

There is a paucity of epidemiologic data among various ethnic groups; however, a few studies have suggested that there is no difference in the frequency rates of positive patch test results in Black vs White populations.^11,13,14 One study of patch test results from 114 Black patients and 877 White patients at the Cleveland Clinic Foundation in Ohio demonstrated a similar allergy frequency of 43.0% and 43.6%, respectively.13 However, there were differences in the types of allergen sensitization. Black patients had higher positive patch test rates for PPD than White patients (10.6% vs 4.5%). Black men had a higher frequency of sensitivity to PPD (21.2% vs 4.2%) and imidazolidinyl urea (a formaldehyde-releasing preservative; 9.1% vs 2.6%) compared to White men.¹³

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