PURPOSE OF THE STUDY.
To review the demographics, referral criteria, efficacy of testing, and comorbid conditions among patients who are evaluated by patch testing for concern for allergic contact dermatitis (ACD).
Data were collected from 157 pediatric patients (3–18 years old, median 13 years old) who were evaluated for patch testing at the Cleveland Clinic Foundation Department of Dermatology from 2005–2015. Of participants, 58.6% were female, and 68.8% were atopic.
A retrospective chart review was conducted with institutional review board approval. Outcomes reviewed included age, sex, history of atopy, comorbidities, referring physician, reason for referral, history of previous patch testing or hospitalization (if any), distribution and appearance of dermatitis, duration of symptoms, skin biopsy results, treatment before patch testing and in follow-up, number of patches placed with result outcomes, and improvement at the follow-up visit. Patch testing was mostly completed based on established criteria outlined by the North American Contact Dermatitis Group (NACDG), and positives were defined as 1+ (weak positive reaction) or greater.
Dermatologists referred the majority of patients (73%), while 20% were referred by primary care providers. Dermatitis was present from <6 months (20%) to 2 years (46.2%). At least 1 positive reaction was seen in 73.25% of cases, and 54.8% had 2 or more positive patch test results. The most frequent positive triggers for ACD were nickel (24.4%) and cobalt (21.7%). Males had more positive results from fragrance mix 1 compared with females (P = .02). Patients with atopy were more likely to have a positive reaction to cobalt (P = .008) and chromium (P = .03). Among the 60 patients who returned for follow-up, 60.7% reported improvement in symptoms after patch testing, and most (88.5%) were being treated with topical corticosteroids.
Patch testing is useful for guiding treatment options for ACD.
This study demonstrates the utility of patch testing when a trigger for the diagnosis of dermatitis is not clear from history or if dermatitis is refractory to standard treatment. Targeted patch testing can be cost-effective and may guide management strategies. Given the rising prevalence of allergic disease and its impact on quality of life, it is important for providers to consider referrals for patch testing before starting treatment with systemic immunosuppressants for allergic contact dermatitis.
- Copyright © 2017 by the American Academy of Pediatrics