Evaluation of Patch Test Findings in Patients With Anogenital Dermatitis

Abstract

IMPORTANCEContact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008.OBJECTIVES To characterize patients with anogenital dermatitis referred for patch testing by the North American Contact Dermatitis Group, to identify common allergens, and to explore sex-associated differences between anogenital dermatitis and allergens. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional analysis was conducted of the North American Contact Dermatitis Group database among 28 481 patients who underwent patch testing from January 1, 2005, to December 31, 2016, at outpatient referral clinics in the United States and Canada. EXPOSURE Patch testing for allergens. MAIN OUTCOMES AND MEASURES Currently relevant allergic patch test reactions in patients with anogenital dermatitis. RESULTS Of 28 481 patients tested during the study period, 832 patients (336 men and 496 women; mean [SD] age, 50.1 [26.5] years) had anogenital involvement and 449 patients (177 men and 272 women; mean [SD] age, 49.6 [17.4] years) had anogenital dermatitis only.Compared with those without anogenital involvement, there were significantly more male patients in the group with anogenital dermatitis (177 [39.4%] vs 8857 of 27 649 [32.0%]; relative risk, 1.37; 95% CI, 1.14-1.66; P < .001). In the group with anogenital involvement, female patients were significantly less likely than male patients to have allergic contact dermatitis as a final diagnosis (130 [47.8%] vs 107 [60.5%]; relative risk, 0.78; 95% CI, 0.64-0.94; P = .01), whereas a final diagnosis of other dermatoses (eg, lichen planus, lichen sclerosus, or lichen simplex chronicus) was more frequent for female patients than for male patients (67 [24.6%] vs 28 [15.8%]; relative risk, 1.54; 95% CI, 1.02-2.31; P = .03). Of the 449 patients in the group with anogenital involvement only, 227 (50.6%) had 1 or more relevant reaction with patch testing. Allergens that were statistically significantly more common in patients with anogenital involvement compared with those without anogenital involvement included medicaments such as dibucaine (10 of 250 patients tested [4.0%] vs 32 of 17 494 patients tested [0.2%]; relative risk, 22.74; 95% CI, 11.05-46.78; P < .001) and preservatives such as methylchloroisothiazolinone and methylisothiazolinone (30 of 449 patients tested [6.7%] vs 1143 of 27 599 patients tested [4.1%]; relative risk, 1.61; 95% CI, 1.14-2.41; P = .008). A total of 152 patients met the definition for anogenital allergic contact dermatitis, which is defined as anogenital involvement only, allergic contact dermatitis as the only diagnosis, and 1 or more positive reaction of current clinical relevance.CONCLUSIONS AND RELEVANCE For patients with anogenital involvement only who were referred for patch testing, male pati...

Iatrogenic allergic contact dermatitis in the (peri)anal and genital area

“…The ratio of men to women with ACD from topical drugs applied onto the anal/genital area was not significantly different from the ratio in the total population tested, that is, more women than men were affected. This differs from the results from a recent study from the United States about patch test results in patients with anogenital dermatitis, 9 in which a higher number of men were involved. However, the authors also took cosmetics into account, in which isothiazolinone preservatives are used.…”

“…Among the allergens identified in topical medication, active principles, mainly corticosteroids and local anaesthetics, which was similar to that described in the United States, 9 were more often involved than vehicle components (Table 1). Regarding corticosteroids, reactions to budesonide and tixocortol pivalate reflect their presence in the baseline test series as contact allergy markers for, for example, amcinonide and hydrocortisone, respectively.…”

Patch Test Reactions Associated With Topical Medications: A Retrospective Analysis of the North American Contact Dermatitis Group Data (2001–2018)

“…Here, medication-positive patients were 2.3 times more likely to have anal/genital dermatitis as compared with medication-negative patients (95% CI, 2.02–2.60; P ≤ 0.0001). A recent study by our group characterizing anogenital dermatitis found that topical anesthetics (dibucaine, benzocaine, lidocaine) and corticosteroids (budesonide, triamcinolone) were significantly more likely positive in patients with anogenital dermatitis 14 . Many vaginal and hemorrhoidal medications contain anesthetics and topical corticosteroids.…”

“…A recent study by our group characterizing anogenital dermatitis found that topical anesthetics (dibucaine, benzocaine, lidocaine) and corticosteroids (budesonide, triamcinolone) were significantly more likely positive in patients with anogenital dermatitis. 14 Many vaginal and hemorrhoidal medications contain anesthetics and topical corticosteroids. Nearly half (9/20) of the 20 best-selling hemorrhoid pain relief products on Amazon include an anesthetic.…”

The Importance of Patch Testing in Anogenital Dermatitis: Ten-Year Experience of a Tertiary Referral Center in Northern Portugal

“…Dear Editor, Anogenital dermatitis is an underreported and underdiagnosed inflammatory skin disease that affects both women and men. 1,2 Allergic contact dermatitis (ACD) affecting the anogenital area is more likely to be developed in skin that was previously injured or exposed to several allergens and irritants. 2,3 We aimed to provide data from a Portuguese tertiary referral center regarding this overlooked condition that is associated with impaired quality of life.…”