Faculty Bibliography

Corticosteroids are the most widely used class of drugs in dermatology. In the past, allergic contact dermatitis to topical corticosteriods was rarely reported. In this article, we present a case of delayed type hypersensitivity to triamcinolone acetonide

BACKGROUND: The panel of patch test allergens used for the evaluation of patients with suspected photoallergy typically does not include plant and pesticide allergens. The prevalence of allergic contact dermatitis and photoallergic contact dermatitis to plant and pesticide allergens was determined for this subgroup of patients. OBSERVATION: Positive reactions were detected in 12 of 26 patients who were tested with our photoallergen series: 5 with allergic contact dermatitis, 5 with photoallergic contact dermatitis, and 2 with both. Four of the 12 patients had positive patch and photo-patch test reactions to plant allergens, pesticide allergens, or both. The positive patch test reactions were to the plants Taraxacum officinale (dandelion) and Tanacetum vulgare (tansy) and to the pesticides folpet and captafol. Positive photo-patch test reactions were to the pesticides folpet and captan. The histories of the patients suggested that 2 or 3 of the 4 patients had clinically relevant reactions. In the other 8 patients, positive reactions to the patch and photo-patch tests included fragrances, sunscreens, and antibacterial agents. CONCLUSION: Plant and pesticide allergens should be included in the patch and photo-patch test series used for the evaluation of patients with suspected photoallergy

This study examines the possibility of using patch contact times shorter in duration than the standard 48 hours. Using varying concentrations of potassium dichromate (K2Cr2O7), this study analyzed results from two sets of patches applied to the backs of 11 subjects for durations of 6 and 48 hours, respectively. Results showed that after the 48-hour application period, all subjects reacted to K2Cr2O7 at some concentration. For the patches applied for 6 hours, 7 of the 11 subjects (64%) reacted to K2Cr2O7 at some concentration. Minimum elicitation thresholds (METs), the lowest concentration at which a reaction was observed, were established for both the 6-hour and 48-hour application times. The ratio of an individual's 6-hour MET to their 48-hour MET was calculated to evaluate the feasibility of patch testing with a higher concentration of an allergen for a shorter time period. Although the results clearly indicated that a higher concentration of allergen is required in order to elicit a reaction at 6 versus 48 hours, a fair amount of interindividual variability is exhibited by these 6-hour to 48-hour MET ratios. This observed variability would seem to preclude the use of 6-hour duration patch contact times for routine patch testing with K2Cr2O7

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