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The 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

https://doi.org/10.1016/j.jaad.2008.05.008Get rights and content

Background

A scattered generalized distribution (SGD) of dermatitis is a challenging problem; patch testing is a strategy for evaluating allergic contact dermatitis as a relevant factor.

Objective

We sought to analyze patient characteristics and most frequently relevant positive allergens in patients presenting for patch testing with SGD.

Methods

We conducted retrospective cross-sectional analysis of North American Contact Dermatitis Group 2001 to 2004 data. Patients with SGD were compared with patients without SGD.

Results

Of 10,061 patients, 14.9% (n = 1497) had only a SGD. Men and patients with a history of atopic eczema were more likely to have dermatitis in a SGD (P < .001). Preservatives, fragrances, propylene glycol, cocamidopropyl betaine, ethyleneurea melamine formaldehyde, tixocortol pivalate, and budesonide were among the more frequently relevant positive allergens. Top allergen sources included cosmetics/beauty preparations/skin and health care products, clothing, and topical corticoids.

Limitations

This was a retrospective analysis of patch-tested patients with SGD suspected to have allergy.

Conclusions

A total of 49% of patients with SGD had at least one relevant positive allergen, thus demonstrating the benefit of patch testing these patients.

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

References (11)

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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.

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