Long‐lasting contact dermatitis in patients with atopic dermatitis or psoriasis

Abstract

Background: The aetiology of contact dermatitis, a common inflammatory skin disorder, is often complex and multifactorial. Objectives: To describe the characteristics of patients with contact dermatitis who also have concomitant atopic dermatitis or psoriasis. Methods: Between 2000 and 2011, adult patients with chronic contact dermatitis (six months or more), which also had concomitant atopic dermatitis or psoriasis, were recruited for a descriptive retrospective study in a tertiary care Spanish hospital. Univariate and multivariate analyses were used for the analysis of the collected data. Results: 76 patients with atopic dermatitis and 130 with psoriasis were recruited. The most frequent site of contact dermatitis in both groups was the hands. The most frequent clinically relevant allergen in both groups was nickel sulphate. According to multivariate logistic regression, a statistically significant association was found between facial contact dermatitis and atopic dermatitis (adjusted OR 0.2 95% CI: 0.05-0.8; P = 0.022). No differences were found between the groups for patch test results (adjusted OR 0.6 CI 95%: 0.3-1.3; P = 0.194). Conclusions: Although the number of patients was limited, our results provide valuable insight on the behaviour of contact dermatitis in patients with atopic dermatitis and with psoriasis. Facial contact dermatitis was positively associated with atopic dermatitis. No differences were found with respect to rates of contact hypersensitivity or positivity to different allergens.

Allergic Contact Cell-Mediated Hypersensitivity in Psoriasis: A Narrative Minireview

“…Because psoriasis alters the skin’s protective barrier, different microbes, irritants, and contact haptens/allergens more easily penetrate the cutaneous layer with presentation to dendritic cells. Therefore, allergic contact hypersensitivity has been reported as a possible comorbidity in psoriasis patients [ 1 , 2 , 3 , 13 ].…”

“…The association between psoriasis and allergic contact hypersensitivity is still a point of discussion and an area for future research. In psoriasis patients, the coexistence of contact hypersensitivity may explain some lesions’ locations, treatment resistance, and prognosis with increased skin disease morbidity [ 2 , 24 , 25 ]. Some authors reported the precipitation of the Köbner phenomenon due to allergic contact hypersensitivity.…”

“…Several studies have revealed higher incidence rates of contact hypersensitivity reactions in patients with psoriasis, while others have shown an inverse relationship between the two skin conditions, and that both conditions have the same prevalence in healthy subjects [ 2 , 22 , 25 , 31 , 32 , 33 ].…”

“…By skin patch-testing palmoplantar psoriasis patients, Žužul et al found that 29.5% were sensitized [ 3 ], while Lipozencić et al reported 41.7% positive patients, compared with only about 6.6% allergic patients in subjects with other psoriasis clinical phenotypes [ 37 ]. Therefore, it was proposed to perform patch tests in patients with palmoplantar psoriasis who are refractory to treatment [ 2 , 22 ].…”

“…It affects all age groups, and its prevalence in the general population varies from 1% to 3%, with differences in various geographical areas due to environmental and genetic factors. Allergic contact dermatitis is caused by contact cell-mediated hypersensitivity and has a prevalence of about 15–20% in the general population [ 1 , 2 , 3 ]. This type IV hypersensitivity may be assessed in vivo with skin patch testing in selected patients with psoriasis and may be treated with either refractory or topical treatments, or with biologics if the patient is presenting with cutaneous lesions clinically suggestive of contact dermatitis.…”