Both children and adult patients with difficult‐to‐treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized

Abstract

BackgroundConcomitant allergic contact dermatitis (ACD) has been described as a possible cause of atopic dermatitis (AD) becoming difficult‐to‐treat. However, contact sensitization in this patient group has barely been studied.ObjectiveTo study the occurrence of ACD in a population of difficult‐to‐treat AD children and adults.MethodsClinical and patch test information of 48 patients with difficult‐to‐treat AD unresponsive to conventional outpatient treatments was gathered retrospectively. We studied prevalence and relevance of common allergens, performed dynamic patch test analysis and assessed occurrence of polysensitization.ResultsIn 48 patients with difficult‐to‐treat AD, 75% (n = 36/48) had a concomitant contact allergy, and 39% (n = 14/36) of these patients were polysensitized. ACD and polysensitization prevalences were equal amongst children and adults. The most frequent and relevant reactions were seen against wool alcohols, surfactants cocamidopropyl betaine and dimethylaminopropylamine, bichromate and fragrance mix I. Dynamic pattern analysis showed these reactions to be mostly allergic and not irritative of nature.ConclusionDifficult‐to‐treat AD patients frequently suffer from concomitant (multiple) contact allergies, and this may be a reason why the AD turns into a difficult‐to‐treat disease. Awareness of this phenomenon is necessary, as pragmatic implementation of allergen avoidance strategies may be helpful in getting disease control in this population.

Methylisothiazolinone allergic contact dermatitis: Assessment of relapses in 139 patients after avoidance advice

“…28 Penetration of MI can be enhanced by changes in the skin barrier or by the presence of atopic inflammatory lesions. 29 In our series, relapses occurred more frequently when the initial localization of the dermatitis was on the hands. The hands are more often exposed to different types of product that are likely to contain MI, including unlabelled industrial applications.…”

“…Cvetkovski et al showed that atopy and atopic dermatitis are risk factors for poor prognosis in the evolution of hand eczema . Penetration of MI can be enhanced by changes in the skin barrier or by the presence of atopic inflammatory lesions . In our series, relapses occurred more frequently when the initial localization of the dermatitis was on the hands.…”

Atopic dermatitis at preschool age and contact allergy in adolescence: a population‐based cohort study

“…This can create diagnostic challenges in clinical practice as well as in epidemiological studies. A recent study of dermatology patients with difficult‐to‐treat AD showed a high prevalence of contact allergy among both children and adults …”

Contact Allergy—Emerging Allergens and Public Health Impact

“…A case of mild angular cheilitis, which could have been mistaken as a "minimal sign" of atopic eczema, was actually due to using a toothpaste with stannuous fluoride; positive patch test reactions were seen to the toothpaste as well as tin 50% pet., which is otherwise an extremely rare allergen [210]. Both children and adult patients with difficult-to-treat atopic dermatitis have high prevalences of concomitant allergic contact dermatitis and are frequently polysensitized [211], hence patch testing to identify contact allergy and secondary ACD to active ingredients or excipients is very important.…”