Materiały źródłowe

• #1 Contact Dermatitis Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/contact-dermatitis-overview

  Contact dermatitis (CD) is a common skin problem occurring in 15% to 20% of people. […] The diagnosis is made from history (what your doctor learns from talking to you including your hobbies, your work exposures, cosmetic/fragrance/hair dye/nail polish exposures, exposure to jewelry and other metals), physical exam and testing. The patch test is used for the diagnosis of contact dermatitis. […] Testing allows identification of chemicals you are allergic to so that they can be avoided in the future.

• #2

  https://link.springer.com/article/10.1007/s13671-021-00351-4

  Irritant contact dermatitis is the most common form of contact dermatitis and the most common occupational skin disease. […] The diagnosis of irritant contact dermatitis is often difficult, as there is no confirmatory test, and it is often a default diagnosis after allergic contact dermatitis has been excluded. Early recognition, prevention, and treatment are vital in management, especially in the occupational setting. […] Large systematic review of interventions in preventing occupational irritant hand dermatitis. It showed the protective role of moisturizers and educational strategies in preventing hand dermatitis. […] Long term follow up multicentre cohort study assessing the impact of tertiary prevention in severe hand eczema demonstrated significant reduction in severity of hand eczema and use of topical corticosteroids and improvement in quality of life scores.

• #3 Contact Dermatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459230/

  Contact dermatitis is an inflammatory eczematous skin disease. It is caused by chemicals or metal ions that exert toxic effects without inducing a T-cell response (contact irritants) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). Contact dermatitis is divided into irritant contact dermatitis and allergic contact dermatitis. […] This activity reviews the causes, pathophysiology, and diagnosis of contact dermatitis and highlights the role of the interprofessional team in its management. […] History regarding occupation, hobbies and any topical or oral medications is important in diagnosing contact dermatitis. Patch testing is considered to be the gold standard in diagnosing contact allergic dermatitis and is used to determine the exact cause. […] Patch testing helps identify which substances may be causing a delayed-type allergic reaction. It produces a local allergic reaction on a small area of the patient’s back, where the diluted chemicals are applied. […] Allergens are placed on Finn chambers and applied on the back. Patches are removed at 48 hours, and final results are read 48-72 hours later. Grading of the reactions is completed based on the International Contact Dermatitis Research Group guidelines.

• #4 Contact dermatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/diagnosis-treatment/drc-20352748

  At the end of the week, patients are provided with a list of what they’re allergic to. […] Your health care provider may be able to diagnose contact dermatitis by talking to you about your signs and symptoms. […] Your health care provider may suggest a patch test to identify the cause of your rash. […] This test can be useful if the cause of your rash isn’t apparent or if your rash recurs often.

• #5 Diagnosis and Management of Contact Dermatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0801/p249.html

  Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. […] When a possible causative substance is known, the first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance. […] If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed. […] The diagnosis of contact dermatitis is most often made with history and physical examination findings. […] A potassium hydroxide (KOH) preparation is useful if tinea or Candida infection is suspected, because these fungal infections can have erythema and scaling similar to contact dermatitis. […] If avoidance and empiric treatment do not resolve the dermatitis or the allergen remains unknown, patch testing may be indicated.

• #6 Contact Dermatitis: Symptoms, Causes, Types & Treatments

  https://my.clevelandclinic.org/health/diseases/6173-contact-dermatitis

  Your healthcare provider will diagnose contact dermatitis after taking a complete medical history, performing a physical exam and reviewing your symptoms. […] For allergic contact dermatitis, your provider may offer testing, including a patch test to confirm a diagnosis. For a patch test, your provider will place a sticky patch on your skin. That patch is coated in common allergens. When your provider removes the patch, theyll be able to see if the allergens on the patch triggered an allergic reaction on your skin. […] There isnt a test to identify the cause of irritant contact dermatitis, but your provider will ask questions to learn more about your environment, things youve come into contact with and the location and size of your rash.

• #7 Contact dermatitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/90

  Irritant contact dermatitis is caused by direct toxicity without prior sensitization, and allergic contact dermatitis is a delayed hypersensitivity reaction. […] Patch testing may aid identification of the causative agent. Skin biopsy may also be helpful, but may not be able to distinguish between other causes of dermatitis. […] Key diagnostic factors include occupational history of exposure, history of atopic dermatitis, previous episodes of similar dermatitis, acute onset, affecting hands and face, affecting sun-exposed skin, sparing of non-exposed areas of skin, pruritus, burning, erythema, vesicles and bullae, urticaria, lichenoid lesions, corrosion or ulceration, pustules and acneiform lesions. […] Other diagnostic factors include scaling, lichenification, social history of exposure, persistence of symptoms, crusting, erythema multiforme, cellulitic lesions, leukoderma, hypopigmentation/depigmentation, hyperpigmentation, purpura, miliaria, alopecia, granulomatous lesions. […] 1st tests to order include patch testing. […] Tests to consider include repeated open application test (ROAT) or provocative use test (PUT), skin biopsy.

• #8 Contact dermatitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742

  Contact dermatitis is an itchy rash caused by direct contact with a substance or an allergic reaction to it. […] To treat contact dermatitis successfully, you need to identify and avoid the cause of your reaction. […] Contact dermatitis shows up on skin that has been directly exposed to the substance causing the reaction. […] Signs and symptoms of contact dermatitis vary widely and may include: An itchy rash, leathery patches that are darker than usual (hyperpigmented), typically on brown or Black skin, dry, cracked, scaly skin, typically on white skin, bumps and blisters, sometimes with oozing and crusting, swelling, burning or tenderness. […] See your health care provider if: The rash is so itchy that you can’t sleep or go about your day, the rash is severe or widespread, you’re worried about how your rash looks, the rash doesn’t get better within three weeks, the rash involves the eyes, mouth, face or genitals. […] It’s very helpful to go to a health provider, especially a dermatologist, to help differentiate between irritant contact dermatitis and an allergy.

• #9

  https://www.nhs.uk/conditions/contact-dermatitis/diagnosis/

  A GP can usually diagnose contact dermatitis from the appearance of your skin and by asking about your symptoms. […] If a GP has diagnosed contact dermatitis, they’ll try to identify what has triggered your symptoms. […] If the allergens or irritants causing your contact dermatitis cannot be identified, you may be referred to a dermatologist (a doctor who specialises in treating skin conditions). […] The best way to test for a reaction to allergens is by patch testing.

• #10

  https://www2.hse.ie/conditions/contact-dermatitis/diagnosis/

  Your GP can usually diagnose contact dermatitis from your symptoms and the look of your skin. […] Your GP will ask when your symptoms first appeared and what substances you’ve been in contact with. […] If your GP diagnoses contact dermatitis, they’ll try to identify the cause. […] Your GP will look at your medical history and ask questions about your lifestyle and job. […] If you cannot identify the cause of your contact dermatitis, your GP may refer you to a dermatologist. […] A dermatologist is a doctor who specialises in treating skin conditions. […] Your GP may also refer you to a dermatologist if you know the cause but your symptoms do not improve with treatment. […] The best way to test for a reaction to allergens is by patch testing. […] After 2 days, the patches are removed and your skin is assessed to check for any reactions. […] Your skin will usually be examined again after another 2 days. […] In some cases, a repeated open application test (ROAT) is useful. […] A ROAT involves putting the substance onto the same area of skin twice a day for 7 days, to see how your skin reacts.

• #11 Contact Dermatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459230/

  Contact dermatitis is an inflammatory eczematous skin disease. It is caused by chemicals or metal ions that exert toxic effects without inducing a T-cell response (contact irritants) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). Contact dermatitis is divided into irritant contact dermatitis and allergic contact dermatitis. […] This activity reviews the causes, pathophysiology, and diagnosis of contact dermatitis and highlights the role of the interprofessional team in its management. […] History regarding occupation, hobbies and any topical or oral medications is important in diagnosing contact dermatitis. Patch testing is considered to be the gold standard in diagnosing contact allergic dermatitis and is used to determine the exact cause. […] Patch testing helps identify which substances may be causing a delayed-type allergic reaction. It produces a local allergic reaction on a small area of the patient’s back, where the diluted chemicals are applied. […] Allergens are placed on Finn chambers and applied on the back. Patches are removed at 48 hours, and final results are read 48-72 hours later. Grading of the reactions is completed based on the International Contact Dermatitis Research Group guidelines.

• #12 Contact Dermatitis Overview

  https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/contact-dermatitis-overview

  Contact dermatitis (CD) is a common skin problem occurring in 15% to 20% of people. […] The diagnosis is made from history (what your doctor learns from talking to you including your hobbies, your work exposures, cosmetic/fragrance/hair dye/nail polish exposures, exposure to jewelry and other metals), physical exam and testing. The patch test is used for the diagnosis of contact dermatitis. […] Testing allows identification of chemicals you are allergic to so that they can be avoided in the future.

• #13 Contact Dermatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459230/

  Contact dermatitis is an inflammatory eczematous skin disease. It is caused by chemicals or metal ions that exert toxic effects without inducing a T-cell response (contact irritants) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). Contact dermatitis is divided into irritant contact dermatitis and allergic contact dermatitis. […] This activity reviews the causes, pathophysiology, and diagnosis of contact dermatitis and highlights the role of the interprofessional team in its management. […] History regarding occupation, hobbies and any topical or oral medications is important in diagnosing contact dermatitis. Patch testing is considered to be the gold standard in diagnosing contact allergic dermatitis and is used to determine the exact cause. […] Patch testing helps identify which substances may be causing a delayed-type allergic reaction. It produces a local allergic reaction on a small area of the patient’s back, where the diluted chemicals are applied. […] Allergens are placed on Finn chambers and applied on the back. Patches are removed at 48 hours, and final results are read 48-72 hours later. Grading of the reactions is completed based on the International Contact Dermatitis Research Group guidelines.

• #14

  https://link.springer.com/article/10.1007/s40521-015-0064-y

  Allergic contact dermatitis (ACD) is a type IV (delayed) hypersensitivity reaction that has a wide spectrum of presentations that often imitate or overlap with other cutaneous eruptions. […] Epicutaneous patch testing remains the gold standard for diagnosing ACD. […] For diagnosis and definitive treatment ACD must be considered within a broad differential diagnosis, but the differential can be narrowed with careful history taking and clues found on physical examination. […] The epicutaneous patch test remains the gold standard for diagnosing ACD. When positive patch test reactions are elicited, the potential relevance of the identified allergens to the dermatitis must be assessed. […] When the diagnosis is in doubt and patch testing does not identify the relevant allergens or allergen avoidance fails to clear the eruption, skin biopsy for histopathologic examination may be helpful in distinguishing ACD from other conditions.

• #15 Diagnosis and management of contact dermatitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20672788/

  Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. […] When a possible causative substance is known, the first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance. […] If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed.

• #16 Contact dermatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/diagnosis-treatment/drc-20352748

  Patients can get allergic to various things that they are using, such as soaps, lotions, makeups, anything that contacts the skin. […] Patch testing is the crucial test that we perform to assess for allergic contact dermatitis. It’s a weeklong test. We have to see patients on Monday, Wednesday and Friday of the same week. […] During the initial visit, the dermatologist determines possible risk factors that may be causing the contact dermatitis. […] Then, based on that, we customize a panel of allergens for each patient that are placed on these aluminum discs that are taped onto the back. […] After two days, the patient comes back to get the patches removed. […] But we also have to see the patient back on Friday because it can take 4 to 5 days before we see reactions. So it’s a weeklong commitment.

• #17 Contact Dermatitis: Causes, Symptoms, Diagnosis | National Eczema Association

  https://nationaleczema.org/eczema/types-of-eczema/contact-dermatitis/

  How is contact dermatitis diagnosed? […] Contact dermatitis is typically diagnosed during a doctor visit. This may include a visit with a primary care physician, a dermatologist and/or an allergist. […] Contact dermatitis is often diagnosed with a physical examination of the symptoms based on appearance and duration. This may include patch testing. This is when the doctor applies patches with small amounts of various allergens to the patients back and then evaluates skin after about 48 hours and 96 hours. Sometimes, a provider may opt for a skin biopsy, where a sample of the skin is taken for lab testing to rule out other skin conditions that may appear like contact dermatitis including psoriasis, seborrheic dermatitis, etc.

• #18 Clinical presentation, diagnosis, differential diagnosis and management of contact allergy – Cosmoderma

  https://cosmoderma.org/clinical-presentation-diagnosis-differential-diagnosis-and-management-of-contact-allergy/

  Contact allergy is an acquired immunological alteration caused by skin, or occasional mucosal or systemic, contact to low molecular weight substances. With skin involvement, this process manifests as contact dermatitis. The approach to patients with contact dermatitis should consist of a detailed (work and leisure) history, skin examination, patch tests with allergens based on history, physical examination, education on materials that contain the allergen and adequate therapy and prevention. The golden standard to diagnose CA is patch test. The first step to diagnose ACD is to take good and detailed personal history along with getting occupational and recreational information. All suspected allergens should be patch tested. Patch test is a gold standard for diagnosis of ACD. In case of a positive patch test result and a positive correlation with the patients history of dermatitis, the diagnosis of ACD can be made. Patch testing should be considered in individuals with acute recurrent dermatitis, chronic contact dermatitis, chronic dermatitis that isnt improving with treatment and with eruptions on skin and mucous membranes. A positive patch test reaction may only indicate sensitivity, and it has to be correlated with patient history in order to find its relevancy. The test area is cleaned with ethanol or water and a standardized amount of allergen is applied to each test chamber and fixed with adhesive tape. The test chambers need to be removed after 48h and the reactions are evaluated on day 2, day 3 or 4 and finally on day 7 (if possible). Once the patch test is completed the relevance of positive allergens should be established. Diagnosis of ACD is suspected from patients history and clinical signs and it is confirmed by patch testing.

• #19 Diagnosing Eczema & Dermatitis | NYU Langone Health

  https://nyulangone.org/conditions/eczema-dermatitis/diagnosis

  NYU Langone dermatologists, with their extensive experience and expertise, may differentiate between atopic, contact, and nummular dermatitis simply by examining the distribution of the rash on your skin and asking questions about your family and medical history. […] Our doctors have also been leaders in the diagnosis of contact dermatitis since the 1930s, when the patch test was brought to the United States and the technique was refined. This allergy test is uniquely designed to identify the cause of contact dermatitis without using needles. The patch test remains the only reliable method of determining which substances cause an allergic reaction when they come into contact with the skin. […] If dermatologists suspect that allergic dermatitis is causing your rash, a patch test is the most effective diagnostic tool.

• #20 Contact Dermatitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459230/

  Contact dermatitis is an inflammatory eczematous skin disease. It is caused by chemicals or metal ions that exert toxic effects without inducing a T-cell response (contact irritants) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). Contact dermatitis is divided into irritant contact dermatitis and allergic contact dermatitis. […] This activity reviews the causes, pathophysiology, and diagnosis of contact dermatitis and highlights the role of the interprofessional team in its management. […] History regarding occupation, hobbies and any topical or oral medications is important in diagnosing contact dermatitis. Patch testing is considered to be the gold standard in diagnosing contact allergic dermatitis and is used to determine the exact cause. […] Patch testing helps identify which substances may be causing a delayed-type allergic reaction. It produces a local allergic reaction on a small area of the patient’s back, where the diluted chemicals are applied. […] Allergens are placed on Finn chambers and applied on the back. Patches are removed at 48 hours, and final results are read 48-72 hours later. Grading of the reactions is completed based on the International Contact Dermatitis Research Group guidelines.

• #21 Diagnosing Eczema & Dermatitis | NYU Langone Health

  https://nyulangone.org/conditions/eczema-dermatitis/diagnosis

  After two days, the panels are removed and a note is made of any areas of irritation. A doctor may not record the final results for up to four days to allow for delayed reactions. On the final reading, our doctors conduct an examination to match signs of reaction on the skin with the substance that was placed there. Redness with elevated skin or a rash at the site of any of the tested allergens may help your dermatologist determine the source of the allergic reaction and confirm a diagnosis of allergic dermatitis. […] At times, a dermatologist needs to remove a small piece of skin for lab testing. This procedure, called a biopsy, is usually only necessary if doctors have not been able to diagnose your condition during a physical exam or patch test. […] In a lab, a pathologist who specializes in skin cells, called a dermatopathologist, examines the sample under a microscope to determine whether eczema or dermatitis is present or if a different skin condition accounts for the rash. Biopsy results take three to seven days.

• #22 Diagnosis of Contact Dermatitis | Hospital Clínic Barcelona

  https://www.clinicbarcelona.org/en/assistance/diseases/contact-dermatitis/diagnosis

  Clinical history. The diagnosis is based on a thorough interview which includes history of skin diseases, occupation, items of personal use, characteristics of the workplace, causes of exacerbation and improvement, development time and severity of the lesions. […] Epicutaneous or patch tests. When an allergen mechanism is suspected as the cause of the clinical picture, this type of test is carried out as the standard diagnostic method. Epicutaneous tests consist of re-exposing the patient to the suspected allergens under controlled conditions. […] Obtaining positive results does not necessarily imply that the allergen obtained is the cause of the lesions that are being studied, as they should be evaluated in the context of the patients medical history.

• #23 Clinical presentation, diagnosis, differential diagnosis and management of contact allergy – Cosmoderma

  https://cosmoderma.org/clinical-presentation-diagnosis-differential-diagnosis-and-management-of-contact-allergy/

  Contact allergy is an acquired immunological alteration caused by skin, or occasional mucosal or systemic, contact to low molecular weight substances. With skin involvement, this process manifests as contact dermatitis. The approach to patients with contact dermatitis should consist of a detailed (work and leisure) history, skin examination, patch tests with allergens based on history, physical examination, education on materials that contain the allergen and adequate therapy and prevention. The golden standard to diagnose CA is patch test. The first step to diagnose ACD is to take good and detailed personal history along with getting occupational and recreational information. All suspected allergens should be patch tested. Patch test is a gold standard for diagnosis of ACD. In case of a positive patch test result and a positive correlation with the patients history of dermatitis, the diagnosis of ACD can be made. Patch testing should be considered in individuals with acute recurrent dermatitis, chronic contact dermatitis, chronic dermatitis that isnt improving with treatment and with eruptions on skin and mucous membranes. A positive patch test reaction may only indicate sensitivity, and it has to be correlated with patient history in order to find its relevancy. The test area is cleaned with ethanol or water and a standardized amount of allergen is applied to each test chamber and fixed with adhesive tape. The test chambers need to be removed after 48h and the reactions are evaluated on day 2, day 3 or 4 and finally on day 7 (if possible). Once the patch test is completed the relevance of positive allergens should be established. Diagnosis of ACD is suspected from patients history and clinical signs and it is confirmed by patch testing.

• #24 Irritant Contact Dermatitis Workup: Approach Considerations, Laboratory Studies, Other Tests

  https://emedicine.medscape.com/article/1049353-workup

  No single diagnostic test exists for irritant contact dermatitis (ICD). The diagnosis rests on the exclusion of other cutaneous diseases (especially allergic contact dermatitis) and on the clinical appearance of dermatitis at a site sufficiently exposed to a suspected or known cutaneous irritant. […] Laboratory studies are generally of little value in proving a diagnosis of contact dermatitis. However, they may be of value in eliminating some disorders from the differential diagnosis. […] Patch testing can be performed to diagnose contact allergies, but there is no patch test capable of proving that a cutaneous irritant is responsible for a particular case of ICD. Diagnosis rests on exclusion of allergic contact dermatitis and a history of sufficient exposure to a cutaneous irritant. […] Skin biopsy can help exclude other disorders, such as tinea, psoriasis, or cutaneous T-cell lymphoma.

• #25 Contact dermatitis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000869.htm

  Contact dermatitis is a condition in which the skin becomes red, sore, or inflamed after direct contact with a substance. […] Your health care provider will make the diagnosis based on how the skin looks and by asking questions about substances you may have come in contact with. […] Allergy testing with skin patches (called patch testing) may be necessary to determine what is causing the reaction. Patch testing is used for certain people who have long-term or repeated contact dermatitis. […] Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion.

• #26

  https://www2.hse.ie/conditions/contact-dermatitis/diagnosis/

  Your GP can usually diagnose contact dermatitis from your symptoms and the look of your skin. […] Your GP will ask when your symptoms first appeared and what substances you’ve been in contact with. […] If your GP diagnoses contact dermatitis, they’ll try to identify the cause. […] Your GP will look at your medical history and ask questions about your lifestyle and job. […] If you cannot identify the cause of your contact dermatitis, your GP may refer you to a dermatologist. […] A dermatologist is a doctor who specialises in treating skin conditions. […] Your GP may also refer you to a dermatologist if you know the cause but your symptoms do not improve with treatment. […] The best way to test for a reaction to allergens is by patch testing. […] After 2 days, the patches are removed and your skin is assessed to check for any reactions. […] Your skin will usually be examined again after another 2 days. […] In some cases, a repeated open application test (ROAT) is useful. […] A ROAT involves putting the substance onto the same area of skin twice a day for 7 days, to see how your skin reacts.

• #27 Contact dermatitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/90

  Irritant contact dermatitis is caused by direct toxicity without prior sensitization, and allergic contact dermatitis is a delayed hypersensitivity reaction. […] Patch testing may aid identification of the causative agent. Skin biopsy may also be helpful, but may not be able to distinguish between other causes of dermatitis. […] Key diagnostic factors include occupational history of exposure, history of atopic dermatitis, previous episodes of similar dermatitis, acute onset, affecting hands and face, affecting sun-exposed skin, sparing of non-exposed areas of skin, pruritus, burning, erythema, vesicles and bullae, urticaria, lichenoid lesions, corrosion or ulceration, pustules and acneiform lesions. […] Other diagnostic factors include scaling, lichenification, social history of exposure, persistence of symptoms, crusting, erythema multiforme, cellulitic lesions, leukoderma, hypopigmentation/depigmentation, hyperpigmentation, purpura, miliaria, alopecia, granulomatous lesions. […] 1st tests to order include patch testing. […] Tests to consider include repeated open application test (ROAT) or provocative use test (PUT), skin biopsy.

• #28 Irritant Contact Dermatitis Workup: Approach Considerations, Laboratory Studies, Other Tests

  https://emedicine.medscape.com/article/1049353-workup

  No single diagnostic test exists for irritant contact dermatitis (ICD). The diagnosis rests on the exclusion of other cutaneous diseases (especially allergic contact dermatitis) and on the clinical appearance of dermatitis at a site sufficiently exposed to a suspected or known cutaneous irritant. […] Laboratory studies are generally of little value in proving a diagnosis of contact dermatitis. However, they may be of value in eliminating some disorders from the differential diagnosis. […] Patch testing can be performed to diagnose contact allergies, but there is no patch test capable of proving that a cutaneous irritant is responsible for a particular case of ICD. Diagnosis rests on exclusion of allergic contact dermatitis and a history of sufficient exposure to a cutaneous irritant. […] Skin biopsy can help exclude other disorders, such as tinea, psoriasis, or cutaneous T-cell lymphoma.

• #29 Contact Dermatitis: Causes, Symptoms, Diagnosis | National Eczema Association

  https://nationaleczema.org/eczema/types-of-eczema/contact-dermatitis/

  How is contact dermatitis diagnosed? […] Contact dermatitis is typically diagnosed during a doctor visit. This may include a visit with a primary care physician, a dermatologist and/or an allergist. […] Contact dermatitis is often diagnosed with a physical examination of the symptoms based on appearance and duration. This may include patch testing. This is when the doctor applies patches with small amounts of various allergens to the patients back and then evaluates skin after about 48 hours and 96 hours. Sometimes, a provider may opt for a skin biopsy, where a sample of the skin is taken for lab testing to rule out other skin conditions that may appear like contact dermatitis including psoriasis, seborrheic dermatitis, etc.

• #30 Diagnosis and Management of Contact Dermatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2010/0801/p249.html

  Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. […] When a possible causative substance is known, the first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance. […] If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed. […] The diagnosis of contact dermatitis is most often made with history and physical examination findings. […] A potassium hydroxide (KOH) preparation is useful if tinea or Candida infection is suspected, because these fungal infections can have erythema and scaling similar to contact dermatitis. […] If avoidance and empiric treatment do not resolve the dermatitis or the allergen remains unknown, patch testing may be indicated.

• #31 Allergic Contact Dermatitis: Symptoms, Causes, and Treatment – DermNet

  https://dermnetnz.org/topics/allergic-contact-dermatitis

  How is allergic contact dermatitis diagnosed? Sometimes it is easy to recognise contact allergy and no specific tests are necessary. Taking a very good history including information on the work environment, hobbies, products in use at home and work and sun exposure will enhance the chances of finding a diagnosis. The rash usually (but not always) completely clears up if the allergen is no longer in contact with the skin, but recurs even with slight contact with it again. […] Dermatologists will perform patch tests in patients with suspected contact allergy, particularly if the reaction is severe, recurrent or chronic. The tests can identify the specific allergen causing the rash. […] Fungal scrapings of skin for microscopy and culture can exclude fungal infection. […] Dimethylgloxime test is available to spot test if a product contains nickel.

• #32

  https://dpcj.org/index.php/dpc/article/view/4338

  Irritant contact dermatitis (ICD) is characterized by direct injury to the epidermal cells, activating the innate immune response. Allergic contact dermatitis (ACD), in contrast, is delineated by a delayed hypersensitivity reaction of type IV. Despite the distinct etiopathogenic mechanisms underpinning each condition, the differentiation between them presents a significant diagnostic challenge. […] This study aims to determine whether a combination of clinical evaluation and noninvasive measurements encompassing oxidative stress, erythema, hydration, melanin content, transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume can distinguish ICD from ACD. […] The evaluation of patients with noninvasive parameters, including transepidermal water loss (TEWL), hemoglobin concentration, and skin texture and volume, could markedly aid in distinguishing irritant contact dermatitis from allergic contact dermatitis (ACD). Nevertheless, the study is constrained by a limited sample size.

• #33 Irritant Contact Dermatitis Workup: Approach Considerations, Laboratory Studies, Other Tests

  https://emedicine.medscape.com/article/1049353-workup

  No single diagnostic test exists for irritant contact dermatitis (ICD). The diagnosis rests on the exclusion of other cutaneous diseases (especially allergic contact dermatitis) and on the clinical appearance of dermatitis at a site sufficiently exposed to a suspected or known cutaneous irritant. […] Laboratory studies are generally of little value in proving a diagnosis of contact dermatitis. However, they may be of value in eliminating some disorders from the differential diagnosis. […] Patch testing can be performed to diagnose contact allergies, but there is no patch test capable of proving that a cutaneous irritant is responsible for a particular case of ICD. Diagnosis rests on exclusion of allergic contact dermatitis and a history of sufficient exposure to a cutaneous irritant. […] Skin biopsy can help exclude other disorders, such as tinea, psoriasis, or cutaneous T-cell lymphoma.

• #34 Irritant contact dermatitis

  https://dermnetnz.org/topics/irritant-contact-dermatitis

  Irritant contact dermatitis may be diagnosed on detailed medical history, including occupational exposures, and clinical examination. There is no test for irritant contact dermatitis. Patch testing may be necessary to distinguish it from allergic contact dermatitis. Irritant and allergic contact dermatitis can co-exist. […] Irritant contact dermatitis develops when chemical or physical agents damage the skin surface faster than the skin can repair.

• #35

  https://bpac.org.nz/bpj/2014/april/dermatitis.aspx

  Contact irritant dermatitis is diagnosed based on the patients history: the affected sites are exposed to irritants with sufficient frequency, duration or concentration to be a plausible cause of the dermatitis; the dermatitis improves or resolves following reduction or cessation of the irritant exposure; and there are no alternative explanations that might better account for the signs and symptoms. […] Contact allergic dermatitis is diagnosed by patch testing: haptens are applied under occlusion to intact skin for up to 48 hours, and then the sites are checked for signs of reaction (erythema, papules, and vesicles). The sites are checked again on day four, and ideally again on day six or seven. […] Contact urticaria is diagnosed by scratch-patch testing (test substances are applied over a superficial scratch, occluded, and left for 20 minutes), or occasionally prick tests or RAST tests.

• #36 Pathogenesis and diagnosis of contact dermatitis: Applications of reflectance confocal microscopy

  https://www.wjgnet.com/2218-6190/full/v3/i3/45.htm

  Contact dermatitis (CD) is the most common professional skin disease, with frequencies ranging from 24 to 170 every 100000 people. Approximately 20% of the United States population suffers from CD. CD is classified into irritant (ICD) and allergic (ACD), with both subtypes displaying sub-acute, acute and/or chronic eczema. The gold standard in CD diagnosis is patch-testing, although its validity and reproducibility are under question. […] The gold standard in CD diagnosis is patch-testing, although its validity and reproducibility are under question. Real-time reflectance confocal microscopy is a very promising tool for the diagnosis and management of ACD and ICD, providing significant advantage over conventional histology (due to the possibility to manage the disease through repetitive assessment) and patch-testing, due to increased sensitivity and specificity.

• #37 Pathogenesis and diagnosis of contact dermatitis: Applications of reflectance confocal microscopy

  https://www.wjgnet.com/2218-6190/full/v3/i3/45.htm

  RCM is therefore a promising tool to study CD since it enables following the temporal evolution of the disease at a cellular and even subcellular level, unlike conventional histology. […] RCM appears superior to conventional histology and patch-testing. In addition to its non-invasive nature that enables repetitive observation of the affected area, its resolution enables an accurate follow-up with a resolution close to that of conventional histology during exploration of areas situated between the stratum corneum and the upper layers of the reticular dermis. […] In summary, RCM is a very promising tool for the diagnosis and management of ACD and ICD, providing significant advantage over conventional histology (due to the possibility to manage the disease through repetitive assessment) and patch-testing, due to increased sensitivity and specificity. Furthermore, RCM can be used to evaluate the response to therapy and evolution of the disease over time.

• #38

  https://link.springer.com/article/10.1007/s40521-015-0064-y

  Allergic contact dermatitis (ACD) is a type IV (delayed) hypersensitivity reaction that has a wide spectrum of presentations that often imitate or overlap with other cutaneous eruptions. […] Epicutaneous patch testing remains the gold standard for diagnosing ACD. […] For diagnosis and definitive treatment ACD must be considered within a broad differential diagnosis, but the differential can be narrowed with careful history taking and clues found on physical examination. […] The epicutaneous patch test remains the gold standard for diagnosing ACD. When positive patch test reactions are elicited, the potential relevance of the identified allergens to the dermatitis must be assessed. […] When the diagnosis is in doubt and patch testing does not identify the relevant allergens or allergen avoidance fails to clear the eruption, skin biopsy for histopathologic examination may be helpful in distinguishing ACD from other conditions.

• #39

  https://link.springer.com/article/10.1007/s40521-015-0064-y

  The differential diagnosis of ACD includes many dermatitides, such as atopic dermatitis, asteatotic eczema (eczema craquele), dyshidrotic eczema, erythrodermas, lichen planus, perioral dermatitis, psoriasis, rosacea, stasis dermatitis, seborrheic dermatitis and others. […] Definitive remission of ACD requires the correct diagnosis and avoidance of causative allergens.

• #40 Atopic Dermatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html

  Atopic dermatitis is a clinical diagnosis with no definitive laboratory test. Approximately 80% of patients with atopic dermatitis are diagnosed and treated in the primary care setting. The American Academy of Dermatology (AAD) has streamlined the diagnosis using previously validated diagnostic criteria. The AAD criteria differentiate essential features that must be present for diagnosis, such as pruritus; important features that support the diagnosis, such as early age at onset; and associated features that suggest the diagnosis but are nonspecific, such as lichenification. […] The Scoring Atopic Dermatitis index is the most widely used validated clinical tool to classify atopic dermatitis severity based on the affected body area and intensity of lesion characteristics. Other validated tools include the Eczema Area and Severity Index; the Investigator Global Assessment scale; and the Six Area, Six Sign Atopic Dermatitis severity score.

• #41 Allergic Contact Dermatitis > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/dermatitis

  How is allergic contact dermatitis diagnosed? Typically a diagnosis of allergic contact dermatitis is made by a dermatologist. Often the shape of the rash will determine the diagnosis. Rashes caused by external factors such as allergens or irritants are usually asymmetrical, and those caused by internal factors such as atopic dermatitis are often symmetrical, meaning that they occur in both sides of the body, for example, on both arms or legs. […] But a successful allergic contact dermatitis diagnosis doesn’t always indicate what caused the reaction in the first place. If someone hasn’t been exposed to a known allergen such as poison oak, it’s necessary to perform patch testing to determine the cause. […] Patch testing involves the application of square patches that are impregnated with a variety of different allergens typically 36 of the most common ones. The patches need to remain on the patient’s skin for about 48 hours to ensure that the skin has time to react to the allergens. Once the patches are removed, it will typically take another 24 to 36 hours for a rash to appear.

• #42 Allergic contact dermatitis

  https://www.visualdx.com/visualdx/diagnosis/allergic+contact+dermatitis?diagnosisId=51384&moduleId=101

  Allergic contact dermatitis (ACD) is a delayed-type (type IV) hypersensitivity reaction that occurs when allergens activate antigen-specific T cells in a sensitized individual. […] Contact dermatitis generally presents with well-demarcated borders, suggestive of an „outside job” or external contact. […] Causative allergens and their clinical importance vary based on several factors, including exposures based on geographic regions, cultural practices, personal care product usage, and manufacturing practices (eg, which preservatives are used). […] Common contact allergens are urushiol (poison ivy, oak, and sumac), nickel, fragrance, cobalt, chromates (leather products), neomycin, thimerosal (ophthalmic preparations and vaccines), adhesives, and oxybenzone (sunscreens). […] ACD can present as a systemic contact reaction with widespread lesions when the offending agent is ingested, present in an implanted device, or used in a manner that covers a large portion of the body (eg, body washes). […] To raise awareness of increasingly common or problematic allergens, the American Contact Dermatitis Society selects an Allergen of the Year.

• #43 Atopic Dermatitis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p590.html

  Atopic dermatitis is a clinical diagnosis with no definitive laboratory test. Approximately 80% of patients with atopic dermatitis are diagnosed and treated in the primary care setting. The American Academy of Dermatology (AAD) has streamlined the diagnosis using previously validated diagnostic criteria. The AAD criteria differentiate essential features that must be present for diagnosis, such as pruritus; important features that support the diagnosis, such as early age at onset; and associated features that suggest the diagnosis but are nonspecific, such as lichenification. […] The Scoring Atopic Dermatitis index is the most widely used validated clinical tool to classify atopic dermatitis severity based on the affected body area and intensity of lesion characteristics. Other validated tools include the Eczema Area and Severity Index; the Investigator Global Assessment scale; and the Six Area, Six Sign Atopic Dermatitis severity score.

• #44

  https://www.nhs.uk/conditions/contact-dermatitis/diagnosis/

  A GP can usually diagnose contact dermatitis from the appearance of your skin and by asking about your symptoms. […] If a GP has diagnosed contact dermatitis, they’ll try to identify what has triggered your symptoms. […] If the allergens or irritants causing your contact dermatitis cannot be identified, you may be referred to a dermatologist (a doctor who specialises in treating skin conditions). […] The best way to test for a reaction to allergens is by patch testing.

• #45

  https://www2.hse.ie/conditions/contact-dermatitis/diagnosis/

  Your GP can usually diagnose contact dermatitis from your symptoms and the look of your skin. […] Your GP will ask when your symptoms first appeared and what substances you’ve been in contact with. […] If your GP diagnoses contact dermatitis, they’ll try to identify the cause. […] Your GP will look at your medical history and ask questions about your lifestyle and job. […] If you cannot identify the cause of your contact dermatitis, your GP may refer you to a dermatologist. […] A dermatologist is a doctor who specialises in treating skin conditions. […] Your GP may also refer you to a dermatologist if you know the cause but your symptoms do not improve with treatment. […] The best way to test for a reaction to allergens is by patch testing. […] After 2 days, the patches are removed and your skin is assessed to check for any reactions. […] Your skin will usually be examined again after another 2 days. […] In some cases, a repeated open application test (ROAT) is useful. […] A ROAT involves putting the substance onto the same area of skin twice a day for 7 days, to see how your skin reacts.

• #46

  https://www.nhs.uk/conditions/contact-dermatitis/

  Contact dermatitis usually improves or clears up completely if the substance causing the problem is identified and avoided. […] See a GP if you have persistent, recurrent or severe symptoms of contact dermatitis. They can try to identify the cause and suggest appropriate treatments. […] A GP may refer you to a doctor who specialises in treating skin conditions (dermatologist) for further tests if: the substance causing your contact dermatitis cannot be identified. […] Read about diagnosing contact dermatitis.

• #47 Contact Dermatitis Diagnosis and Management: When to Refer for Patch Testing

  https://practicingclinicians.com/the-exchange/contact-dermatitis-diagnosis-and-management-when-to-refer-for-patch-testing

  Diagnosis of CD is often clinical and based on history and physical exam. […] If avoidance of the potential trigger and empiric treatment do not relieve symptoms, patch testing may be indicated. […] Patch testing attempts to recreate an allergic reaction to allergens to confirm or rule out potential triggers. […] One indication for patch testing includes patients with distributions that are highly suggestive of ACD, such as involvement of the hands, feet, face, or eyelids. […] If there is unilateral involvement, ACD should also be suspected, and therefore patch testing is indicated. […] Further, if a patient has a clinical history highly suggestive of ACD, patch testing should be performed. […] Patch testing should also be performed on patients that are in high-risk occupations for ACD, including healthcare workers, cosmetologists, and machinists.

• #48 Contact Dermatitis Diagnosis and Management: When to Refer for Patch Testing

  https://practicingclinicians.com/the-exchange/contact-dermatitis-diagnosis-and-management-when-to-refer-for-patch-testing

  If dermatitis remains uncontrolled or unresponsive to treatment, or there is worsening of dermatitis that was previously controlled, patch testing should be considered. […] It is important to note that ACD can occur in response to topical medical treatments. […] Patients should be referred to an allergist to discuss the appropriate panel(s) for testing and protocols for performing patch testing correctly. […] Patch testing is typically completed on intact skin (usually the back) and occluded for 2 days. […] Readings of patch tests are typically performed at 48 hours, with another delayed reading at 72 to 96 hours or later. […] While non-irritating concentrations have been established to provide accurate results, unfortunately patch testing only has sensitivity and specificity of 70% to 80%.

• #49 Contact dermatitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742

  Contact dermatitis is an itchy rash caused by direct contact with a substance or an allergic reaction to it. […] To treat contact dermatitis successfully, you need to identify and avoid the cause of your reaction. […] Contact dermatitis shows up on skin that has been directly exposed to the substance causing the reaction. […] Signs and symptoms of contact dermatitis vary widely and may include: An itchy rash, leathery patches that are darker than usual (hyperpigmented), typically on brown or Black skin, dry, cracked, scaly skin, typically on white skin, bumps and blisters, sometimes with oozing and crusting, swelling, burning or tenderness. […] See your health care provider if: The rash is so itchy that you can’t sleep or go about your day, the rash is severe or widespread, you’re worried about how your rash looks, the rash doesn’t get better within three weeks, the rash involves the eyes, mouth, face or genitals. […] It’s very helpful to go to a health provider, especially a dermatologist, to help differentiate between irritant contact dermatitis and an allergy.

• #50 Allergic Contact Dermatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1049216-overview

  Individuals with allergic contact dermatitis may have persistent or relapsing dermatitis, particularly if the material(s) to which they are allergic is not identified or if they practice inappropriate skin care. […] Diagnostic studies for allergic contact dermatitis include the following: Patch testing: To identify external chemicals to which the person is allergic. […] A detailed history, both before and after patch testing, is crucial in evaluating individuals with allergic contact dermatitis. Before patch testing, the history identifies potential causes of allergic contact dermatitis and the materials to which individuals are exposed that should be included in patch testing. After patch testing, the history determines the clinical significance of the findings. […] The definitive treatment for allergic contact dermatitis is the identification and removal of any potential causal agents; otherwise, the patient is at increased risk for chronic or recurrent dermatitis.

• #51 Allergic Contact Dermatitis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1049216-overview

  The prognosis depends on how well the affected individual can avoid the offending allergen. […] Individuals with allergic contact dermatitis may have persistent or relapsing dermatitis, particularly if the material(s) to which they are allergic is not identified or if they continue to practice skin care that is no longer appropriate.

• #52 Patch testing can find what’s causing your rash

  https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash

  If your skin reacts to something and your dermatologist suspects youre having an allergic reaction, your dermatologist will try to find whats causing the reaction. […] If your skin continues to itch and develop rashes, your dermatologist may recommend a medical test called patch testing. […] Patch testing differs from a skin prick test. […] The patches are normally applied to your back and must be left in place for a period of time. […] If patch testing reveals that you have one or more allergies, your dermatologist will create a treatment plan. […] Because so many things that touch our skin can cause contact dermatitis, its possible that the first round of patch testing fails to find whats causing your skin to react. […] Once your dermatologist knows the cause (or causes) of your contact dermatitis, your dermatologist will create a plan to help you avoid whats causing your rash.

• #53 Patch testing can find what’s causing your rash

  https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash

  Some dermatologists offer extensive patch testing. This means that they can test you for many different substances that could be causing your allergic skin reaction. […] For many patients, the results from patch testing significantly improve their lives. Once you know whats causing your itchy rash, you can avoid it. This often leads to clearing.

• #54 Patch testing can find what’s causing your rash

  https://www.aad.org/public/diseases/eczema/types/contact-dermatitis/patch-testing-rash

  Some dermatologists offer extensive patch testing. This means that they can test you for many different substances that could be causing your allergic skin reaction. […] For many patients, the results from patch testing significantly improve their lives. Once you know whats causing your itchy rash, you can avoid it. This often leads to clearing.

• #55

  https://link.springer.com/article/10.1007/s40521-015-0064-y

  The differential diagnosis of ACD includes many dermatitides, such as atopic dermatitis, asteatotic eczema (eczema craquele), dyshidrotic eczema, erythrodermas, lichen planus, perioral dermatitis, psoriasis, rosacea, stasis dermatitis, seborrheic dermatitis and others. […] Definitive remission of ACD requires the correct diagnosis and avoidance of causative allergens.

• #56 UC Davis Health | Department of Dermatology | Contact Dermatitis – Patch Testing

  https://health.ucdavis.edu/dermatology/specialties/medical/contact_dermatitis.html

  Patch testing is the standard technique for making a diagnosis of allergic contact dermatitis and determining culprit allergens. […] The diagnosis of allergic contact dermatitis is made collaboratively between your primary skin provider and a patch test specialist using patient history, physical exam findings, laboratory (such as biopsy), and patch test results.

• #57 UC Davis Health | Department of Dermatology | Contact Dermatitis – Patch Testing

  https://health.ucdavis.edu/dermatology/specialties/medical/contact_dermatitis.html

  Patch testing is the standard technique for making a diagnosis of allergic contact dermatitis and determining culprit allergens. […] The diagnosis of allergic contact dermatitis is made collaboratively between your primary skin provider and a patch test specialist using patient history, physical exam findings, laboratory (such as biopsy), and patch test results.

• #58 Contact dermatitis | Nature Reviews Disease Primers

  https://www.nature.com/articles/s41572-021-00271-4

  Contact dermatitis (CD) is among the most common inflammatory dermatological conditions and includes allergic CD, photoallergic CD, irritant CD, photoirritant CD (also called phototoxic CD) and protein CD. […] The diagnosis relies on clinical presentation, thorough exposure assessment and evaluation with techniques such as patch testing and skin-prick testing. […] The European Society of Contact Dermatitis guidelines represent a comprehensive set of recommendations for patch testing in clinical practice. […] For many years, allergen avoidance, topical corticosteroids, phototherapy and traditional, systemic immunosuppressants have been the mainstay for the treatment of CD; targeted therapies represent a new and exciting approach to benefit patients with recalcitrant disease.

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