ReportThe value of patch testing patients with a scattered generalized distribution of dermatitis: Retrospective cross-sectional analyses of North American Contact Dermatitis Group data, 2001 to 2004
Section snippets
Patient selection
Deidentified patch testing data from 13 sites are compiled regularly by the NACDG.7 Data collection of the NACDG is Health Insurance Portability and Accountability Act compliant and designated as institutional review board exempt (Dartmouth-Hitchcock Medical Center Committee for the Protection of Human Subjects #16236). Although up to 3 anatomic sites affected by a rash can be entered per patient, only patients with the site “scattered generalized” as the sole site entered were included in this
Patient characteristics
Of 10,061 deidentified patients, 1497 (14.9%) met the study criteria of SGD only. In all, 378 patients with site listed as scattered generalized plus another site of involvement were excluded from this analysis. The comparison group consisted of 8186 patients without “scattered generalized” listed as any of the 3 possible site locations. Characteristics of the two study groups are listed in Table I. Men were more likely to have a SGD than were women. In addition, a history of atopic eczema was
Discussion
Approximately 15% of the patients patch tested by the NACDG had an SGD only. This is similar to a study from Thailand that found that 9.3% of 129 patients referred for patch testing had SGD.8 Approximately half of our patients with SGD had a final diagnosis that included allergic contact dermatitis.
Interestingly, men presenting for patch testing were statistically more likely than women to have SGD. The reasons for this finding are unknown and require further study. The higher prevalence of a
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Cited by (34)
Contact dermatitis
2023, Personal Care Products and Human HealthExperience in patch testing: A 6-year retrospective review from a single academic allergy practice
2019, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :Clinical history may provide clues for potential allergens and should include time of onset and possible contact with allergens/irritants, clinical pattern, working environment, leisure activities, domestic products, skin care products, reactions to jewelry/clothing, and history of previous dermatitis.12 Clinical information is oftentimes not enough to identify which allergen(s) may be the cause of ACD, and studies have shown that history and physical examination alone have only modest sensitivity (76%) and specificity (76%).13,14 Patch testing (PT) remains the gold standard for diagnosis and has been performed since the 1800s with little change in the procedure.15
Contact Dermatitis
2016, Pediatric Allergy: Principles and Practice: Third EditionContact Dermatitis for the Practicing Allergist
2015, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Although the exposure and medical history is very useful, studies have shown that the history and physical examination have moderate sensitivity and specificity for diagnosing ACD.23 In 1 study, in 50% of the patients with nonspecific generalized dermatitis, contact sensitization was demonstrated to clinically relevant sensitizers.24 Although atopic dermatitis is associated with an abnormal skin barrier, it is uncertain whether patients with atopic dermatitis are at a greater risk for ACD than are nonatopic individuals.25
Contact Dermatitis: A Practice Parameter-Update 2015
2015, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :For example, it has been reported that a positive PT to nickel sulfate is demonstrable in only 60% of patients with a positive history of nickel allergy (ie, positive predictive value 60%), whereas 12.5% to 15% of persons reporting a negative history of metal allergy had a positive PT response to nickel sulfate.3,11 Patch testing identifies contact sensitizers in nearly 50% of patients presenting with scattered generalized dermatitis.12 The experienced clinician can misclassify ACD as nonspecific eczema or IgE-mediated CU if the assessment is based solely on the medical history without patch testing.13,14
Supported by the general research fund, Section of Dermatology, Dartmouth-Hitchcock Medical Center.
Conflicts of interest: None declared.
Presented at the Annual Meeting of the American Academy of Dermatology, Washington, DC, on February 1, 2007.
Reprints not available from the authors.