Flexural Eczema Versus Atopic Dermatitis

Abstract

Flexural eczema and atopic dermatitis are frequently synonymized. As respiratory atopy is rarely tested for and found in these patients, systematically equating a flexural distribution of dermatitis with atopic dermatitis may too frequently result in misclassified diagnoses and potentially missed opportunity for intervention toward improving patients' symptoms and quality of life. We present a critical review of the available evidence for the atopic dermatitis diagnosis and discuss the similarities between atopic dermatitis and allergic contact dermatitis. Because neither flexural predilection nor atopy is specific for atopic dermatitis, we conclude that the term atopic dermatitis is a misnomer and propose an etymologic reclassification of atopic dermatitis to "atopy-related" dermatitis. Allergic contact dermatitis can induce an atopic dermatitis-like phenotype, and thus, flexural dermatitis cannot be assumed as atopic without further testing. Patch testing should at least be considered in cases of chronic or recurrent eczema regardless of the working diagnosis.

Nickel Dermatitis

“…This preferential reaction in flexural areas with brief but intense contact may be due to entrapment of nickel particles, as well as increased susceptibility in a moist environment. 3 Patch testing was performed with the North American Contact Dermatitis Group screening series (SmartPractice, Phoenix, Ariz). In addition, select metal compounds (Chemotechnique, Malmo, Sweden) were tested, including palladium chloride, titanium, titanium (IV) oxalate, titanium (IV) oxide, and nickel sulfate 5%.…”

Nickel-Free Alternatives Raise Awareness

“…18 Consumers should be aware that pieces of jewelry that are in contact with parts of the body that encounter moisture or sweat may be more prone to reactions. 19 Similarly, items that cause more friction or pressure on the skin will also increase risk of sensitization. For example a loose bracelet is less likely to cause dermatitis than a snug ring even if both items contain the same amount of nickel.…”

An Integrated Approach to Management of Food Allergy – Recommendations for Consumers and Professionals

“…and is very difficult to tell apart from the latter. 13 Furthermore, delayed type allergy was proposed as explanation for some cases of urticaria, 14 asthma, 15 and allergic rhinitis. 16 "Classical" protein allergens, like eggs, milk, peanuts, legumes, etc.…”