Contact Sensitization in the Anal and Genital Area

Abstract

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.

Propolis

“…112 A worker in a retail store had contact dermatitis which wasV unconvincinglyVascribed to beeswax a in wood varnish. 118 Other sources of sensitization to propolis include cosmetics 119 and ''biocosmetics'' or ''natural cosmetics.'' 92,114 Thus, propolis is an important allergen in patients with leg ulcers/lower-leg dermatitis, 115Y117 and the frequency of sensitization is greater than 5% in patients with anal dermatoses.…”

The Normal Vulva, Vulvar Examination, and Evaluation Tools

“…Studies report various results of positive reaction to patch testing, ranging from 16% to 78%. [34][35][36][37] This wide range is explained partially by different populations tested, either patients suffering from general vulvar pruritus, specific dermatoses or highly suspected of contact dermatitis, and whether the reaction measured was relevant to the clinical presentation. It is commonly agreed, that the rate of allergic and irritant contact dermatitis among patients suffering from vulvar symptoms is high, and it is not uncommon to find it complicating other established vulvar condition.…”

Understanding the role of cutaneous allergy testing in anogenital dermatoses: a retrospective evaluation of contact sensitization in anogenital dermatoses

“…This provides an ideal environment for the development of allergic contact dermatitis (ACD). Previous studies have reported rates of ACD of 29–54% in patients investigated with cutaneous allergy testing for vulval symptoms and in up to 63% in patients with anogenital symptoms …”