Faculty Bibliography

BACKGROUND: Patch testing remains the standard for the diagnosis of allergic contact dermatitis. The validity and usefulness of a standard patch test allergen series has not been addressed adequately by previous studies. OBJECTIVE: We sought to examine the utility of the standard allergen series as a sole screening tool in the diagnosis of allergic contact dermatitis. METHODS: The charts of 732 patients referred for patch testing were reviewed for positive patch test results. The group of patients with positive reactions was stratified into two groups based on the clinical relevance of their reactions. These groups were subsequently analyzed to determine whether the reactions were to part of the standard series of allergens or to part of a supplementary group. RESULTS: Of patients tested, 50% had a positive patch test. Of those, 221 (30%) had reactions deemed clinically relevant. Only 23% of patients with positive patch tests reacted to an allergen(s) in the standard series exclusively. When adjusted for clinical relevance, only 15.7% of patients were completely evaluated with the standard series of 20 allergens. CONCLUSION: The standard allergen series of 20 allergens available in the United States is limited as a screening tool when used alone in the evaluation of patients with allergic contact dermatitis

We evaluated two patients with allergic contact dermatitis that resulted from exposure to color film developers. A lichenoid eruption developed in one patient, whereas an eruption more characteristic of an acute spongiotic dermatitis developed in the second patient. Histologic findings in the first case were those of a 'lichenoid dermatitis' but with features distinct from classic lichen planus. The biopsy specimens from the second patient showed a subacute spongiotic process with a bandlike infiltrate suggestive of an evolving lichenoid process. Contact allergy to color developers may result in eruptions similar to lichen planus. This process appears to evolve from an acute spongiotic dermatitis in its early phase to a lichenoid dermatitis in fully developed and more chronic forms. Although the histologic features are those of a 'lichenoid' dermatitis, some features, such as the presence of spongiosis, eosinophils, and a less intense inflammatory infiltrate, may enable distinction between lichenoid allergic contact dermatitis and true lichen planus. In addition, clinicopathologic correlation with patch test results should permit accurate diagnosis in most cases

Allergic contact dermatitis to a topical ophthalmic anesthetic, proparacaine, is reported in a patient with refractory glaucoma. His ophthalmologist routinely used a preparation containing this anesthetic, which is an uncommon sensitizer, for measuring the patient's intraocular pressure. That the patient did not apply the medication himself resulted in added difficulty in discovering the iatrogenically induced contact allergy. Avoidance of this anesthetic resulted in resolution of the patient's recurrent bouts of periocular dermatitis and conjunctivitis. The importance of testing patients suspected of having contact allergy to all medications to which they are exposed is emphasized

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership

Alstroemeria (Peruvian or Inca lily) has found particular favor because of its beauty and durability. However, it may induce a dermatitis so severe that workers have to change jobs. The dermatitis is chronic, with fissuring at the tips of the fingers bilaterally. Itching is often a less prominent symptom. Preventative measures are of little benefit, and many floral shops are vanishing the plant