Clinico-epidemiological study of role of patch test in hand eczema

Background: Hand eczema is a common distressing condition in different occupational groups caused by various endogenous and exogenous factors. It appears to be the most common occupational skin disease, comprising 80% or more of all occupational contact dermatitis. Patch test at present is the only scientific method to diagnose the contact allergen and in subsequent management of patient.Methods: An observational study of patch test was conducted on 100 patients of hand eczema in the department of DVL, Basaveshwara Teaching and General Hospital, Kalaburagi. After detailed history and complete examination, patch testing was done using Indian Standard Series and graded by International Contact Dermatitis Research Group criteria at 48 hours and 72 hours.Results: Out of 100 patients, there were 28 females and 72 males. The commonest age group seen was 20-40 years followed by 40-60 years. Commonest sensitizers were to potassium dichromate (34%) followed by nickel (18.7%), Parthenium (12.5%), PPD (7.8%), other (26%). Out of 64 patients who were positive, 82.8% were positive to single allergen, 10% to two allergens and 6.2% to multiple allergens.Conclusions: Patch test is considered as gold standard method for diagnosis of allergic contact dermatitis and thus preventing the morbidity of repeated episodes of eczema.

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Using Patch Testing to Improve Therapeutic Outcome in the Treatment of Hand Eczema in Vietnamese Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.051 ◽

2019 ◽

Vol 7 (2) ◽

pp. 204-207 ◽

Cited By ~ 1

Author(s):

Phuong Pham Thi Minh ◽

Trang Thi Minh ◽

Doanh Le Huu ◽

Thuong Nguyen Van ◽

Sau Nguyen Huu ◽

...

Keyword(s):

Contact Dermatitis ◽

Patch Test ◽

Clinical Features ◽

Potassium Dichromate ◽

Nickel Sulfate ◽

Hand Eczema ◽

Test Reaction ◽

Positive Patch Test ◽

Causative Agents ◽

Allergic Contact

BACKGROUND: Hand eczema is a common chronic and relapsing skin disease with various clinical features. Hand eczema aetiology can be allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), atopic dermatitis (AD) and unknown or combination causes. If the causative agents are not detected treatment of hand eczema will be a failure. A patch test can be useful to detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema. In Vietnam, patch test has not been used before, so we conduct this study. AIM: To identify causative allergens by using patch test with 28 standard allergens in consecutive patients. METHODS: A group of 300 HE patients from the National Hospital of Dermatology and Venereology (NHDV) in Vietnam were enrolled in this study. They were divided into 4 groups-ACD, ICD, AD and unknown aetiology. The patient was patch tested with 28 standard allergens to identify the causative agents. RESULTS: Among the 300 HE enrolled patients, ACD accounted for 72.7%, AD and ICD had the same rate of 12.7%. 39.3% of the patients had a positive patch test. Reaction to nickel sulfate was the most common (10.3%), followed by potassium dichromate (9.7%), cobalt (4%) and fragrance mix (3.1%). About one-third of the cases had relevant clinical reactions correlated with the contact agents and clinical history. Males reacted to cement, thiuram mix and formaldehyde more than females, while females reacted to a nickel more than males. CONCLUSIONS: Hand eczema has variable clinical features and diverse aetiology. ACD is an important cause of hand eczema that can be managed with a patch test to detect causative allergens. Nearly 40% of HE cases had positive patch test. Relevant patch test reactions were seen in one-third of the patients. We propose using patch test detect causative agents in suspected allergic contact hand eczema. Then patients will avoid contacting them. This results in the improvement of hand eczema.

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Common Contact Sensitizers among Patients with Hand Eczema: A Multicenter-Study in Nepal

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v14i1.15809 ◽

2016 ◽

Vol 14 (1) ◽

pp. 14-17

Author(s):

S. Bhattarai ◽

A. Rijal ◽

S. Agrawal

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Patch Test ◽

Patch Testing ◽

Potassium Dichromate ◽

College Teaching ◽

Hand Eczema ◽

Contact Allergens ◽

Allergic Contact

Introduction: Allergic contact dermatitis in Nepal is not an uncommon disorder. Patch testing is a well established method of diagnosing allergic contact dermatitis. Patients with contact dermatitis are well known to have impaired quality of life which often leads to frequent dermatological consultations.Objective: Lack of data from Nepal has prompted us to undertake this study with the aims to know the frequency of allergic contact dermatitis and the commonest contact allergens among the patients with Hand eczema attending the out-patient department of dermatology, B.P. Koirala Institute of Health Sciences and Kathmandu Medical College Teaching Hospital.Material and Methods: A total of 256 patients were included in the study. Out of them 195 with hand eczema agreed to participate and undergo patch testing. The antigens used included the Indian standard series of patch test allergens approved by Contact and Occupational Dermatoses Forum of India.Results: Hundred and ten cases (56.4%) were patch test positive (PTP) at 48 as well as 96 hours to at least one allergen. PTP was seen more commonly in females. The most common allergen in females was nickel sulphate followed by cobalt chloride, gentamicin and mercapto mix while males were positive to potassium dichromate, followed by epoxy resin, fragrance mix and nickel sulphate.Conclusion: Patch testing has proved a useful tool for the detection of allergic contact dermatitis and for identification of contact allergens. When positive reactions correlate with environmental exposure the test usually assists the physician in establishing the cause of dermatitis, hence treating the patients and improving their quality of life.Nepal Journal of Dermatology, Venereology & Leprology, Vol.14(1) 2016, pp.14-17

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Occupational Chromium Allergy and Contact Dermatitis: 10 Years Evolution

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.79.3.1356 ◽

2021 ◽

Vol 79 (3) ◽

pp. 221-226

Author(s):

Alexandre Afonso ◽

Joana Silva ◽

Ricardo Silva ◽

Vânia Pacheco ◽

Vítor Pinheiro ◽

...

Keyword(s):

Contact Dermatitis ◽

Potassium Dichromate ◽

Allergic Sensitization ◽

Occupational Activity ◽

Patch Tests ◽

Hand Dermatitis ◽

Occupational Contact Dermatitis ◽

High Prevalence ◽

Allergic Contact ◽

The Impact

Introduction: Chromium has been responsible for occupational skin disease, both irritant and/or allergic contact dermatitis. In order to minimize this problem, regulatory measures limiting its use have been implemented. The impact of these regulations should be monitored over time. Material and Methods: A retrospective study from 2009 to 2018 was carried out in the Department of Dermatology to assess the temporal trend of chromium sensitization evaluated by patch testing with potassium dichromate 0.5% pet, particularly considering age, sex and its relationship with occupational activity. Results: 3277 individuals were studied, 2369 females (72.29%) and 908 males (27.71%). Of those 621 (18.95%) fulfilled criteria for occupational contact dermatitis. Chromium allergy was found in 118 (3.60%) patients, 64 females (54.4%) and 54 males (45.76%). We found that male patients were significantly more frequent (45.76% vs 27.03%; p<0.001), as well as occupational dermatitis (31.35% vs 18.47%; p<0.001), hand dermatitis (53.54% vs 23.52%; p<0.001) and age above 40 years (70.34% vs 56.76%; p=0.003). Discussion/Conclusion: The results show a high prevalence (3.60%) of chromium positive patch tests. In our study, there has not been a significant decrease in sensitization to chromium over the years. Interestingly cases classically related to this allergy (cement in the building industry) are no longer the main cause of the problem. We found other sources such as leather as a main cause of allergic sensitization, suggesting a change of the panorama.

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Role of contact allergens in chronicity and relapses of nummular eczema

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20170972 ◽

2017 ◽

Vol 3 (2) ◽

pp. 213

Author(s):

Renu Rattan ◽

Gita R. Tegta ◽

Vinay Shanker ◽

Ghanshyam K. Verma ◽

Anuj Sharma ◽

...

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Environmental Conditions ◽

Significant Risk ◽

Contact Allergens ◽

Hilly Region ◽

International Contact ◽

Exogenous Factors ◽

Allergic Contact ◽

Nummular Eczema

Background: Endogenous eczemas are often complicated by exogenous factors like environment and contact allergens. Nummular eczema, a variant of endogenous eczema is no exception to this. Our study aimed at investigating the incidence of allergic contact dermatitis and finding offending agent responsible for chronicity or relapsing course of nummular eczema in patients from a hilly region with cold and dry environmental conditions.Methods: Forty patients of nummular eczema with a mean age of 39.1±19 years were patch tested with the Indian Standard Patch Test Series. Positive reactions were graded as per recommendations of International contact dermatitis research group.Results: Twenty one out of forty patch tested patients showed positive reactions. The most common allergens were found to be: fragrance mix in seven (17.5%) patients, nickel in five (12.5%) patients, PPD in three (7.5%) patients and gentamicin in two (5%) patients. Sensitivity to thiuram mix, black rubber mix, P. tert. butylphenol formaldehyde, neomycin, benzocaine and chinoform was observed in one patient each (2.5% each). Conclusions: Patients of nummular eczema of a hilly region are at a significant risk of developing allergic contact dermatitis owing to xerosis due to dry environmental conditions. This results in chronic nature of their disease. Patch testing should be considered in such patients and avoidance of offending allergens can improve their quality of life.

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Role of footwear allergens in juvenile plantar dermatosis

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20171569 ◽

2017 ◽

Vol 3 (2) ◽

pp. 223

Author(s):

Shyni Perumbil ◽

Kunnummal Muhammed ◽

Sarita Sasidharan Pillai

Keyword(s):

Contact Dermatitis ◽

Patch Test ◽

Potassium Dichromate ◽

Past History ◽

Test Reaction ◽

Positive Patch Test ◽

International Contact ◽

History Of ◽

Age And Sex

Background: Juvenile plantar dermatosis (JPD) is characterized by shiny dry fissured dermatitis of the plantar surface of the foot, affecting children aged 3-14years. The most accepted theory is that JPD is a frictional contact dermatitis of the forefoot in which atopics are more prone to develop. Allergic contact dermatitis remains a close differential diagnosis; it can aggravate the predisposing JPD. In this background we carried out a study among children aged fourteen years and below with clinically diagnosed JPD to know the age and sex profile, aggravating factors and clinical features in this part of the country.Methods: All children aged 14 years and below with JPD attending our outpatient department from November 2006 to November 2007 were included in this study. Using a preset proforma, data regarding age and sex, information on any relation to footwear, past history of allergic disorders in person or family members was collected. All the 40 patients were patch tested using the footwear allergen series in petrolatum base. Patch test unit was removed after 48hours and the results were interpreted using criteria laid down by International Contact Dermatitis Group (ICDRG). The data was analyzed and made an attempt to understand the role of footwear allergy in JPD.Results: 22 girls and 18 boys attended our OPD with JPD between the age group of 4-14 years. 52.5% were using footwear made of plastic; 25%used leather; 12.5% rubber footwear. Patients presented with erythema and glazed appearance of foot along with fissuring. The areas of involvement were distal soles and toes in 70%, distal sole alone in 7.5% and distal sole and dorsum of toes in 22.5% of patients. Personal history of atopy was documented in 15% of patients and family history of atopy was present in 20% of cases. 20% of patients complained of exacerbation with footwear. Of the 40 patients who underwent patch testing, 10% only showed positive patch test reaction mainly to potassium dichromate (5%). Conclusions: JPD is not an uncommon disease and it predominantly affects school going children. Seasonal variation was associated with aggravation of disease. Specific footwear was identified to cause flare ups in a significant percentage of study population (20%) and this was proven by patch test results in half of them. Though nearly one fifth of the affected had an atopic diathesis in person or family, the present data suggests that JPD is not exclusive to atopics. A large sized study is required to evaluate the role of footwear in JPD.

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A study on incidence of various allergens involved in allergic contact dermatitis by patch testing among 150 patients in a tertiary care hospital in South India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20181820 ◽

2018 ◽

Vol 4 (2) ◽

pp. 205

Author(s):

V. N. S. Ahamed Shariff ◽

K. Deepa ◽

L. Balamurugan ◽

S. Nirmala

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Patch Test ◽

Patch Testing ◽

Potassium Dichromate ◽

Tertiary Care ◽

Care Hospital ◽

Female Ratio ◽

Allergic Contact ◽

Male To Female

Background: Allergic contact dermatitis is common dermatoses seen among patients attending dermatology clinics. Allergic contact dermatitis is due to delayed type of hypersensitivity reaction. The diagnosis of allergic contact dermatitis is made by patch testing. A positive reaction to a patch test commonly proves the cause of dermatitis.Methods: A retrospective study was conducted to estimate the incidence of various allergens among 150 patch test positive patients with allergic contact dermatitis who had attended the dermatology OPD in Rajiv Gandhi Government General Hospital, Chennai, between October 2014 and September 2016. All the details regarding history, examination findings, investigations and patch test results were collected from case records, the data were tabulated and analysed.Results: Allergic contact dermatitis to cement was the commonest (44.7%), followed by nickel (10%) and plant antigens (9.3%). The commonest allergen to be tested positive was Potassium dichromate (82 cases), followed nickel (15 cases) and formaldehyde (8 cases). Most of the patients were in the age category between 41 and 50 years (47 cases– 31.33%). Male to female ratio was 2.41:1. 14 were atopic individuals (9.33%) by Hanifin and Rajka's criteria. Allergic contact dermatitis in 103 cases of our study were of occupational in origin (67%).Conclusions: Avoidance of allergen and proper preventive measures in workplace and day to day activities will lead to significant decrease in the morbidity of the disease and improvement in quality of life in patients with allergic contact dermatitis.

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Association Between IL16 Gene Polymorphism and Allergic Contact Dermatitis Among Construction Workers

Immunology and Immunogenetics Insights ◽

10.1177/1178634519880556 ◽

2019 ◽

Vol 11 ◽

pp. 117863451988055

Author(s):

Eman Omar Khashaba ◽

Mohammad A Gaballah ◽

Ahmed Fathy State ◽

Mona Elwassefy

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Patch Test ◽

Potassium Dichromate ◽

Gene Promoter ◽

Mercury Chloride ◽

Gene Distribution ◽

Positive Patch Test ◽

Significant Difference ◽

Allergic Contact

Objectives: First, this research was instituted to identify common allergens, and second, to test the association between IL16 gene promoter polymorphism rs4778889 T/C and allergic contact dermatitis (ACD). Methods: A case control study was conducted in dermatology outpatients’ clinic. Study subjects received interview-based semi-structured questionnaire, complete skin examination, IL16 gene promoter was investigated by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) analysis, and IQ Ultra™ patch test units (Chemotechnique Diagnostics AB, Sweden) with 10 substances were used. Results: Most of the prevalent cases had positive patch test (93.3%). The most common clinical presentation of ACD in our patients was itching (96.7%), followed by dryness (86.75%), erythema (76.7%), and fissuring (76.7%). There was higher CC gene distribution among cases, but there was no statistically significant difference. IL16 gene distribution was nearly similar among different clinical presentations. Formaldehyde showed statistically significant higher frequency for CC. The most common allergen found was mercury chloride (76.6%), followed by potassium dichromate (26.6%) and cobalt chloride (20%). Conclusions: The current study found prominent metal sensitization (mercury chloride) over the previously known potassium dichromate. There was no statistically significant IL16 gene distribution among cases compared with control. However, C allele was more frequently encountered in cases. Further studies are required to test the association with IL16 genotype and ACD and highlight the new trends in metal sensitization among cement-exposed workers.

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Patch testing in allergic contact dermatitis

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004289 ◽

2009 ◽

Vol 123 (5) ◽

pp. 558-559 ◽

Cited By ~ 1

Author(s):

J Keir ◽

J English ◽

N Fergie

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Patch Test ◽

Standard Method ◽

Patch Testing ◽

Gold Standard ◽

Gold Standard Method ◽

Topical Medication ◽

Allergic Contact ◽

Screening Device

AbstractA deterioration in chronic inflammatory ear disease despite topical medication, or failure of the condition to improve with such treatment, should raise the possibility of allergic contact dermatitis. Allergen testing (patch testing) is the ‘gold standard’ method of identifying an agent causing allergic contact dermatitis.We describe an ENT patch test series applied by our department as a screening device for this condition.

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Common allergens in patients with contact dermatitis identified using patch test in a tertiary care centre in North Kerala

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20185054 ◽

2019 ◽

Vol 5 (1) ◽

pp. 78

Author(s):

V. P. K. Gopinath ◽

V. M. Simi ◽

K. Basheer Ahammed ◽

C. M. Ali Rishad ◽

P. M. Farisa

Keyword(s):

Contact Dermatitis ◽

Patch Test ◽

Potassium Dichromate ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Dermatology Department ◽

Patch Tests ◽

Immune Mediated ◽

Allergic Contact ◽

Age Range

Background: Allergic contact dermatitis (ACD) is a disease characterised by an immune mediated response to a substance. The primary prevention remains avoidance of the implicated allergen. This is done with the help of patch test using the Indian Standard series (ISS).Methods: Out of the 246 cases of ACD that came to our Dermatology department, 92 patients were selected and subjected to patch testing using the ISS. Results were read after 48 and 96 hours, interpreted as per ICDRG criteria and were analysed.Results: From 92 patients 59.8% were males and 40.2% were females. Majority of the individuals with ACD who were patch tested belonged to the age range of 21-60 years accounting to 72.8%. The most affected site was the foot. 26.7% showed positivity to Black rubber mix, followed by potassium dichromate 20% and nickel 14.4%. 7.8% produced delayed reactions with positivity revealed at the final reading. One patient gave multiple positive reactions to paraben, PPD and chlorocresol.Conclusions: In the study middle aged males were mostly affected which may be influenced by the sample selected. Black rubber mix was identified as the most frequent sensitizer followed by potassium dichromate which was also implicated as the sensitizer most seen in the unskilled generally. Fragrance mix was responsible for all delayed responses yielding positivity in the second reading. When not considering the negligible left, patch tests’ results could be correlated with the clinical presentations. Patients were treated, educated on ACD and advised to refrain from exposure with suggestions of possible alternatives.

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Study of Common Allergens in Patients with Allergic Contact Dermatitis: A Hospital Based Study

Nepal Medical College Journal ◽

10.3126/nmcj.v23i1.36222 ◽

2021 ◽

Vol 23 (1) ◽

pp. 16-22

Author(s):

Arnija Rana ◽

S Shrestha ◽

AK Jha ◽

DP Thapa ◽

S Joshi ◽

...

Keyword(s):

Contact Dermatitis ◽

Allergic Contact Dermatitis ◽

Patch Test ◽

Patch Testing ◽

Potassium Dichromate ◽

Nickel Sulphate ◽

Dermatology Department ◽

Positive Patch Test ◽

Number Of Patients ◽

Allergic Contact

Allergic contact dermatitis (ACD) is one of the most common diseases presenting to the Dermatology department. The one and only method of preventing as well as treating this disease is avoidance of the allergen causing it. The identification of the allergen causing the ACD is possible by performing patch testing. The purpose of this study was to identify common allergens among patients with ACD using Indian standard series (ISS) of patch test. Clinically suspected cases of ACD were included in the hospital based cross-sectional study from January to December 2017. These cases underwent patch testing with the ISS. The study assessed the following variables: sex, age, occupation, site and positive patch test results. There were a total of 58 patients among which, 36.2% were males and 63.8% were females with a mean age of 32.36±12.51 years. Positive patch test reactions were seen in 63.0% of patients. The most common allergens were nickel sulphate (51.4%), fragrance mix (37.8%), potassium dichromate (8.1%), colophony (8.1%) and black rubber mix (8.1%). Among male, most common allergens were fragrance mix (57.1%), nickel sulphate (28.6%) and potassium dichromate (21.4%) while in female, most common allergens were nickel sulphate (65.2%) and fragrance mix (26.1%). In our study, majority of the allergens were positive. Hence, the ISS used in the study might be suitable in the context of Nepalese population. However, further similar studies on large number of patients with multiple allergens are required to determine the exact number of contact allergens prevalent in our population.

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