Allergic contact dermatitis to personal

care products and topical medications in

adults with atopic dermatitis

Ol eh Pembimbing
Fatiya Hi dayati d r. Enda ng So e k maw ati, Sp.K K
30101306943
 Journal identity

Author :
Title :
Supriya Rastogi, BA,a
Allergic contact
Kevin R. Patel, BS,a
dermatitis to personal 2018 by the American
Vivek Singam, BLA,a
care products and and Academy of
topical medications in Dermatology, Inc.
Jonathan I. Silverberg,
adults with atopic MD, PhD, MPHa,b,c,d
dermatitis
Chicago, Illinois

contact hypersensitivity to
The association between
atopic dermatitis (AD) and
allergic contact dermatitis
is not well understood.
Background
We found that AD was
associated with
Patch testing should be
ingredients considered for patients
with AD who do not
found in emollients and improve with standard
topical medications, and measures.
with sensitivity to
multiple allergens.
 Objective

To determine the predictors of allergic contact

dermatitis and relevant allergens in AD.
 Methods
Study design A retrospective 502 adults (age 18 years) patch patch-testing clinic during 2014-2017
tested at the Northwestern
ATOPIC DERMATITIS Medicine
Current AD was
diagnosed using the
Patches were applied to the patient’s upper back
Hanifin and Rajka
and removedafter 48 hours. Negative reactions included
criteria.13 Past AD was
defined as patient- weak or irritant responses. Positive
reported medical reactions were further classified as +,
evaluated at 48 hours, and
history of AD with ++, and +++ per the International
again at 72 hours
no current disease per Contact Dermatitis Research Group’s
history and physical scoring system
exam. Those without
past or present
AD were defined as
non- D controls.
Statistical analysis
All statistical analyses were performed
using SAS version 9.4 (SAS Institute,
Cary, NC). Chisquared and Fisher’s
exact tests were used to compare AD
and positive reactions to contact
allergens. A 2-sided P value <0.05 was
taken to indicate statistical
significance.
Multivariable multinomial logistic
regression was performed to
determine the association between
polysensitization (defined as ≥3
positive reactions) and AD. Adjusted
odds ratios (aORs) and 95% confidence
intervals (CIs) were estimated. Sex
(male or female), race (white or
nonwhite), and age (<40 years or ≥40
years) were included as covariables.
RESULTS
Contact allergen hypersensitivity
Distribution of skin lesions
 Polysensitization
Polysensitization occurred more
commonly in patients with AD
than without (35 [32.4%] vs 75
[19.0%]; P = .01).
 DISCUSSION
In this study, we describe a
complex relationship
between AD and ACD. These results are consistent
with those from a meta-
analysis of 56 studies,
there were no differences in
PPTRs among those with
current AD, past AD, and no AD

Adults with current AD and past AD had
significantly higher rates of positive and
relevant patch-test reactions to
ingredients in their personal care products
and topical medications.
analysis of a registry of patch-testing results from 1142 children
across the United States found that children with AD had more
positive reactions to cocamidopropyl betaine, lanolin, and
tixocortol pivalate.
In another study, 641 French children with AD were patch
tested with their current emollient and 6 common topical
treatments.
PPTRs were observed in 6.2%, with positive reactions occurring
most frequently with their emollient and chlorhexidine. Risk
factors associated with developing contact sensitization to
the AD treatment included AD onset before 6 years of age, IgE-
mediated sensitization, and moderate-to severe AD

Current AD was associated with
allergen polysensitization, even after
correcting for cross-reactors.
In a previous questionnairebased case-control study of 562
polysensitized and 1124 monosensitized and doublesensitized
individuals, 45.1% of the polysensitized individuals and 31%
of the monosensitized and doublesensitized individuals
reported having AD.
Female sex was inversely associated with polysensitization
in multivariable regression models
The only lesion distribution significantly associated
with allergen hypersensitivity was the presence
of lesions on the arms. However, this lesion localization
might be related to the arms being the most
common site of eczematous lesions among AD
patients overall
 Finally, caution should be taken when
interpreting patch-test results in AD patients.

There is a complex relationship between Previous reports have suggested that AD patients more
current AD and ACD, with potentially frequently have irritant reactions to nickel, cobalt, chromate,
overlapping mechanisms, symptoms, and and lanolin, which can result in false positives.
lesion morphology and distribution.
Conclusion
In conclusion, current AD and past AD patients had higher rates
of ACD to multiple ingredients in their personal care products
and topical medications. Future studies are underway to
determine the impact of contact allergen avoidance on the
clinical course and severity of AD.
AD patients had more positive patch-test reactions to ingredients in their
personal careproducts, topical steroids, and antibiotics.