Anogenital Dermatitis in Patients Referred for Patch Testing

Warshaw, Erin M.; Furda, Laura M.; Maibach, Howard I.; Rietschel, Robert L.; Fowler, Joseph F.; Belsito, D.; Zug, Kathryn A.; DeLeo, Vincent A.; Marks, James G.; Mathias, C. G. Toby; Pratt, Melanie D.; Sasseville, Denis; Storrs, Frances J.; Taylor, James S.

doi:10.1001/archderm.144.6.749

Cited by 53 publications

(11 citation statements)

References 32 publications

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“…Previous studies report high rates of sensitizations to local anaesthetics [1,2,4,14]. Our results confirm high sensitization rates in patients with anogenital dermatoses to cinchocaine followed by tetracaine, benzocaine and lidocaine.…”

Section: Local Anaestheticssupporting

confidence: 88%

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Contact Sensitization in the Anal and Genital Area

Bauer¹,

Oehme²,

Geier³

2011

Current Problems in Dermatology

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We analysed the patch test results in 1,374 patients suffering from dermatoses in the anogenital area (n = 561 genital dermatoses, n = 470 anal dermatoses, n = 343 anogenital dermatoses) patch tested in 44 dermatological departments of the Information Network of Departments of Dermatology from 2004 to 2008. All other patients patch tested during this time period without anogenital dermatoses formed the control group (n = 49, 142). Of the total study group, 662 (48.2%) patients were male. 179 (13%) had a past or present atopic dermatitis. The vast majority of the patients was older than 40 years (n = 989, 72%). Suspected allergen sources were first of all topical medicaments, followed by cosmetics, cleansing agents, clothes, rubber products, systemic medicaments and disinfectants. Allergic contact dermatitis was diagnosed in 409 (29.8%) of the tested patients. Patients with anogenital dermatoses were sensitized mainly to active agents of topical medicaments, in particular bufexamac (5.3%). Sensitization pattern and sensitization rates observed in patients with genital and anal involvement differed significantly. Patients with anal disease had significantly higher sensitization rates for bufexamac (9.4 vs. 1.1%), fragrance mix I (8.7 vs. 4.2%) and II (4.5 vs. 2.6%), propolis (5.4 vs. 1.9%) and methyldibromoglutaronitrile (6.3 vs. 4.1%). Patients with chronic anal dermatoses seem to have a higher risk to develop sensitizations to topically applied products and drugs than patients with genital dermatoses. Recommended patch test series (German Contact Dermatitis Research Group) are standard series, local anaesthetics series, topical antibiotics, antimycotics, steroids, ointment bases and preservative series as well as the patients' own products.

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Section: Local Anaestheticssupporting

confidence: 88%

“…Moreover, especially patients with anogenital dermatoses seem to have an elevated risk to become sensitized [1][2][3][4].…”

mentioning

confidence: 99%

Contact Sensitization in the Anal and Genital Area

Bauer¹,

Oehme²,

Geier³

2011

Current Problems in Dermatology

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“…Causes of allergic contact dermatitis include plants (e.g., poison ivy), metallic salts, germicides, plastic resins, rubber additives, and fragrances [Mathias 1990]. In patients with occupational contact dermatitis who were skin-patch tested, the most common relevant allergens included thiuram mix, carba mix, bacitracin, methyldibromo glutaronitrile/ phenoxyethanol, formaldehyde, glutaraldehyde, methylmethacrylate, nickel, cobalt, and chromium [Warshaw et al 2007[Warshaw et al , 2008.…”

Section: Appendix B: Detailed Personal Exposure Measurements Appendixmentioning

confidence: 99%

Evaluation of metalworking fluid exposure and dermatitis among rifle barrel manufacturing employees.

2016

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“…In cases of ACD, where the cause is discovered to be, for example, a preservative found in food or cosmetics (e.g. sodium metabisulphite, isothiazolinones, or iodopropynyl butylcarbamate), or a medicament used to treat AE, other proctological condition or an unrelated condition 18,19, early management strategies involve withdrawing the allergen.…”

Section: Non-medical Management Of Aementioning

confidence: 99%

“…A small study has reported high rates of acute contact dermatitis with corticosteroids, neomycin, bacitracin, dibucaine and benzocaine used in preparations for application to the vagina and haemorrhoids 19. In the case of corticosteroids, the authors postulated that this might be explained by enhanced penetration in the anogenital area.…”

Section: Topical Treatmentsmentioning

confidence: 99%

Therapeutic management of anal eczema: an evidence‐based review

Havlíčková

Weyandt²

2014

Int J Clin Pract

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AimTo conduct a systematic review of treatments for anal eczema (AE).MethodsWe conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted.ResultsThe evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients.DiscussionFeatures of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today.ConclusionThis review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared.

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Anogenital Dermatitis in Patients Referred for Patch Testing

Cited by 53 publications

References 32 publications

Contact Sensitization in the Anal and Genital Area

Contact Sensitization in the Anal and Genital Area

Evaluation of metalworking fluid exposure and dermatitis among rifle barrel manufacturing employees.

Therapeutic management of anal eczema: an evidence‐based review

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