25th Annual Meeting of the American Contact Dermatitis Society March 20, 2014 Denver, Colorado

Oral Presentations Allergic Contact Dermatitis and Atopy Mark G. Kirchhof 1 and Gillian C. de Gannes1,2 Author Affiliations: 1Department of Dermatology and Skin Science, University of British Columbia; 2Division of Dermatology, Department of Medicine, St. Paul’s Hospital, Vancouver, BC, Canada Atopy is a genetic predisposition to the development of allergic reactions and the increased production of IgE upon exposure to environmental antigens. Clinical manifestations of atopy include asthma, atopic dermatitis (AD) and allergic rhinoconjunctivitis (ACR). We hypothesized that the prevalence of allergic contact dermatitis (ACD) would be higher among patients with a history of atopy and with a familial predisposition to atopy. For this study, we reviewed the patch test database of the UBC Contact Dermatitis Clinic from 2008 to 2012. A personal history of asthma, AD and ACR was recorded. In addition, a family history was obtained and manifestations of atopy in family members were noted. Our data show that the odds ratio (OR) of a positive patch test with a personal history of atopy was 1.39, while the OR of a positive patch test with a family history of atopy was 1.69. Patients with a personal history of atopy also reacted to greater number of allergens than patients with no history of atopy. We conclude from our study that patients with a personal or family history of atopy have an increased risk of ACD and that atopic patients react to a greater number of allergens. These results provide further evidence for the link between atopy and ACD. Immediate Type I and Patch Test-Confirmed Type IV Hypersensitivity to Corticosteroids in the Same Patient Gerardo Marrazzo, MD, and Ponciano Cruz Jr, MD Author Affiliations: The University of Texas Southwestern Medical Center, Dallas, Texas Corticosteroids are used to treat many inflammatory disorders including allergic conditions, but paradoxically have become an increasing cause of allergic reactions. While IgE-mediated, type I hypersensitivity to corticosteroids remains exceedingly rare, the prevalence of T cell-mediated type IV hypersensitivity exemplified by allergic contact dermatitis has approached 5% in some studies. We report the case of a 47 year-old woman with a history of severe asthma, treated with a multitude of different steroids during her life, who complained of a dermatitis that worsened with topical steroids. She also suffered an episode of generalized urticaria, tongue swelling, and difficulty breathing necessitating subcutaneous epinephrine following an intramuscular injection of triamcinolone. Patch testing to the North American Contact Dermatitis Group-80 panel and to a steroid panel (Chemotechnique) revealed positive reactions to tixocortol pivalate, budesonide, and triamcinolone acetonide. She was referred to an allergist to flesh out the strong likelihood of concomitant type I hypersensitivity to corticosteroids. To our knowledge, our patient is the first case of allergic contact dermatitis to corticosteroids confirmed by patch testing to have type IV hypersensitivity while also experiencing classic type I symptoms. Only 3 previous cases in the literature have reported a combined reaction. Two of those cases were due to intranasal steroids and the third case had negative patch testing (and therefore unconfirmed type IV hypersensitivity). Cutaneous Delayed-Type Hypersensitivity in Patients with Atopic Dermatitis: Reactivity to Surfactants Cristin N. Shaughnessy1, Dana Malajian2, and Donald V. Belsito3 Author Affiliations: 1University of Louisville School of Medicine, Louisville, Kentucky; 2Columbia University College of Physicians and Surgeons, New York, New York; 3Department of Dermatology, Columbia University Medical Center, New York Background: Patients with atopic dermatitis (AD) have abnormalities in skin barrier function, and are predisposed to developing cutaneous delayed-type hypersensitivity. Soap and detergents are known to exacerbate the breakdown of the skin barrier. Objective: We sought to assess whether atopic patients in our database were more likely than non-atopic patients to patch test positive to the surfactants cocamidopropyl betaine (CAPB) and cocamide DEA, or to the surfactant precursor amidoamine. Methods: Between January 1, 2001 and the present, a total of 1674 patients underwent patch testing to the NACDG standard screening series. The incidence of positive patch tests to CAPB, cocamide DEA, and amidoamine among patients with AD (n=242) and without AD (n=1422) was assessed. Statistical analysis was done using a χ2 test. Results: AD was associated with contact hypersensitivity to CAPB, but not to cocamide DEA or amidoamine. Conclusions: Patients with AD should avoid the use of skincare products containing the surfactant CAPB, but need not avoid products containing cocamide DEA. Post-Traumatic Eczema Teri Greiling, Michael Girardi, Angela Galan, and Kalman Watsky Author Affiliations: Yale-New Haven Hospital, New Haven, Connecticut A 25-year old woman was referred for evaluation of a 3-year history of recurring localized pruritic skin eruptions after venipuncture that began 24-48 hours after a hypodermic needle pierced the antecubital fossa. Patch testing with an expanded North American Contact Dermatitis Research Group Screening Series and a Metals Series (Chemotechnique) was negative at 2 and 4 days, suggesting that the metal needle was not the inciting factor. A glass slide was used to lightly scratch her volar forearm. Approximately 48 hours later she reported pink papules and pruritus around the site. Examination on days 3 and 6 revealed a 10 cm cluster of edematous pink papules surrounding the scratch site. A similar scratch in the popliteal fossa also reacted with surrounding papular eczema but a scratch to the flank had no response. A biopsy from day 6 showed focal spongiosis with a mixed perivascular and interstitial infiltrate composed of lymphocytes and eosinophils. Immunohistochemical stains from day 1, 3, and 6 provided insight into the temporal progression of inflammatory cells that could be implicated in the pathophysiology of this reaction. This patient has a rare case of “idiopathic post-traumatic eczema,” as characterized by Mathias (Mathias, 1988), although her specific clinical and histopathologic reaction may be better categorized as localized post-traumatic autosensitization. Intriguingly, she was to in in atopic dermatitis and to this in of Patch in American Patients and Author Affiliations: of Medicine, of Dermatology, Clinic Background: The of allergic contact dermatitis (ACD) and patient skin may in Objective: patch testing results of American patients a at the Clinic Methods: of patients as or patch testing between and 2012. The was and of Results: patients patients had at positive from patch were total positive patch test reactions. patients had a history of atopy eczema or and of were the The and were a of patients had more than patients had The of patients a of ACD. ACD in patients more and is and an response. a patients may a in due to of of Patch for of and Author Affiliations: of Dermatology University Canada Background: of as localized or generalized or hypersensitivity to a of the or is of the may be Methods: Between and referred patients for of to patients were patch with the NACDG standard and with a series. were after 48 and Results: patients with generalized or localized to the had positive patch tests of and patients without skin were referred of of or with or without or of Patch tests to show allergic to or of in patient with around a showed positive tests to and In our to or was a rare in 4 In the of and the of or dermatitis could not be by allergic The A Clinical to Contact Dermatitis MD and MD Author Affiliations: Department of Dermatology, University School of Medicine, Approximately in in North and from some of contact contact dermatitis (ACD) from exposure to or that have for as or ACD at a clinical We a clinical to in and We report cases of ACD that with of the skin of the a that we have the The of the the and a history of may to of the In we the of ACD by our clinical the in some by patch patients dermatitis showed of the and In the clinical patient known positive the may a the to the patient to avoid exposure to the In our this the of contact as patients at and therefore an clinical in the of ACD. Cutaneous Hypersensitivity Dermatitis Michael C. MD and MD Author Affiliations: University Medical Center, Department of Dermatology, North We report a case of localized dermatitis associated with a A woman to our with a of 3 the patient was In the patient an on her at the of of her While the was the patient in this a cm was on the with a Skin biopsy was with a hypersensitivity reaction. confirmed the of a in the of the to the Patch testing to including a panel of reaction to 4 and the dermatitis during patch the of metal hypersensitivity. We conclude that the is the likely cause of the localized cutaneous hypersensitivity reaction. is a for patch testing in patients with concomitant dermatitis and of Patch in the of Allergic Contact Dermatitis to MD, Gerardo Marrazzo, MD, and Ponciano Cruz Jr, MD Author Affiliations: The University of Texas Southwestern Medical Center, Dallas, Texas A old with was treated with a topical containing and in was an at the of to the the to but the patient a to the using the to of the but of We a patch test by the to of the topical Patch testing with showed a positive reaction to but not the including of from the in without a that was the are used to topical to as exemplified by this first reported case of allergic contact dermatitis to patch testing is a for the in cases with that are not in standard patch test series. St. Patch in by the MD Author Affiliations: School of at Medical Center, New dermatitis is in patch testing is to the of allergens or to allergic contact We data from patch with a or by the North American Contact Dermatitis Group from to and used data for positive patch test and positive patch test were and and were with of and and in not from or with different allergens had that between and to in for and and increased for of patch test was in and between and test the of for patch testing in to to allergens. Contact to a Contact Dermatitis MD and MD Author Affiliations: University of Department of Dermatology, Canada Background: the American Contact Dermatitis of the are in a of and products including the are not the be allergens in delayed-type hypersensitivity reactions IV allergic Objective: A is who had her with that with no reaction. Approximately 1 the patient a dermatitis to her The reaction but later the patient a contact dermatitis after a Methods: The patient was patch to the North American Contact Dermatitis standard screening and and and the and from Patch test were at 48 and Results: The patient was patch test positive to many and This case likely a reaction to a as as to and the for contact dermatitis with to in and Author Affiliations: University School of Medicine, of College of of Dermatitis Two a and a sought for on the of and had the after of a used as a with to were patch with and and with the North American had positive reactions to 2 and The that the had using and were to avoid further of the on of The also had positive reactions to and and the also had positive reactions to and but no clinical could be for allergens. for should be in and with dermatitis may to provide from exposure to this Contact Dermatitis in and Author Affiliations: of Dermatology and of and University of Department of and St. Canada and contact dermatitis is the clinical type of contact in the include and in to The of this study was to the to of with Methods: A was the to of Results: In to of the had allergic contact of the not in a to In to skin and of or the of in to Conclusions: exposure are an to to in I to and Author Affiliations: 1University of School of Medical Center, have used in is in following who were to by or of A of I has at the Medical of the at is to associated with Methods: were This study was reviewed and by the and the exposure was using A and exposure history was also Results: a of were in the exposure while were in the were in of the of the and was increased in the dermatitis and were also assessed. Conclusions: and was increased in to of of this to by the Department of MD and Author Affiliations: Department of Medicine, of Dermatology, de Canada is of the in but is also used in different as and has referred to as a contact although are We a case of allergic contact dermatitis to in an The patient with a history of an and of the and after in this A of allergic contact dermatitis was after patch testing with allergens and and Two were To our this case is of a to the of and is the first to be reported in the a of and are to be the in is as a topical should be in as a in cases of contact of and Atopy on and Author Affiliations: 1Department of Dermatology, University Medical of Background: and atopy the risk of contact dermatitis may the risk of allergic Objective: patients evaluation for allergic contact dermatitis who or have a history of dermatitis are more likely to be to and to patients who or who have no history of atopy. Methods: patients patch between were as or and in this patch tests to from the standard screening that could be as and strong as by the were Results: and were to the standard screening series. dermatitis was more in the than was a higher of positive patch tests to in the and to in the was no in the of positive patch tests to strong in Conclusions: not as to to by that patients with atopic dermatitis are likely to become to we a prevalence of positive patch tests to in patients with a history of and allergens are more likely to cause in and to clinical patients with a history of atopic patch testing should include the many in personal products for dermatitis should the risk of to as of study may not and and A MD, Author School of Medicine, and are used in the the prevalence of use in with eczema is is whether use of in the may be associated with higher eczema We sought to the eczema prevalence in with We data from the from a of of in the used with using to treat The used to treat eczema were and used for were to be associated with increased eczema including odds ratio and of were associated with eczema including but not or are used for the of eczema in some may be to the skin and be associated with higher eczema prevalence in the are to the and of in Contact Dermatitis in Clinical and of Contact In a of of North and Author Affiliations: of Dermatology, Medical College of of University of and of a to is the known as in the of from the that used for as as is also as a of many and contact dermatitis due to is an reported and Methods: The study was in with the University of and of in a with history and clinical evidence of contact dermatitis due to were patch with allergens Series Series and to different of the Results: of positive reactions were The allergens in standard for of the positive reactions. and different of for of positive allergic reactions. those patients with positive to the of the were of or The data in the study that dermatitis is a clinical with clinical and has a strong as an in those this Patch testing with different of the has a to in out the of the of to of Allergic Contact Dermatitis and Contact Author The of contact allergens has in our in with the North Contact Dermatitis have from screening of a for to of the and of allergic contact dermatitis (ACD) patch test and were used to assess the of of into the of to skin of for associated with and analysis of patch test This a for of allergens using and the and for study of from of ACD and suggesting the as a of and the of and patch test be that of provide insight ACD and and were and in Patch Patients and Author Affiliations: School of and Department of Medicine, University of and Department of St. Hospital, and is known the of with contact The of the study were to the of those for patch testing and and for Methods: patients patch a that obtained the and and to the for evaluation of skin Results: a first for would were not or were not with and for were were not better and were to a and to the patch test 6 to the patch test were and to Conclusions: This study on the for an and the and to These could be to the of and to and from to in a and Author Affiliations: Department of Dermatology and University Hospital, University of Background: from a were from into to the and risk for Methods: from a of in were in to a and in a clinical including patch testing Results: The incidence of eczema was The prevalence of eczema in the was and the prevalence with higher prevalence in the clinical had in of for eczema were atopic dermatitis with as was a risk with of at eczema among was associated with severe Conclusions: A incidence and prevalence of eczema was in old and was associated with eczema and atopic dermatitis with and of in was no to or in Contact but 4 and Author Affiliations: of Medical and University of Canada Background: We that contact allergens have an to contact This is by and but is not known contact allergens also use Methods: A panel of different contact allergens and 3 different contact were for cells and and was by of Results: of the contact allergens and from the contact had similar but no and from cells but not The contact allergens and to from the contact allergens are of but to are on cells but from of in Oral and Author Affiliations: of Dermatology, of Oral Background: containing have to To contact to in patients with and to study of of the on Results: patients were in of Group A in contact with Group cm the of Group of Group but no and Group but no Patch tests were positive in was the in patients by and of and in 1 patients were positive to more than In of patients who for of was in 6 in and no in of was after a of after Contact to is an in and of should be to patients who have in to the The MD, and Author Affiliations: Department of Dermatology, University Medical Center, The for was in and evidence that are or likely of have not patch and is to should be 4 of the in the or more of the on in In this study, we These should be by patients allergic to specific and are for study to are This allergic patients to likely products to The has the to include the containing and MD, A A and MD A A MD, A MD MD A G. MD Presentations of Contact to in and the of Patch and Author Dermatology, University of contact dermatitis results a patient skin manifestations due to or that contact the from as and This study a for and a patient with on the likely to be the cause of the the clinical the and of patch the of and our many to and patients on to avoid products in a patient with is in following the to the dermatitis should patients to and products that the skin The and of should be noted. should be on While patch tests are should for testing patients with These are to the likelihood of the that patch testing be with testing and to the Clinical of Contact Dermatitis and Department of Dermatology, University of are in skin products as and to cause allergic contact We the to patch testing for 1 and use testing of the of in and our in to the of contact contact dermatitis from a is the should be for that patch testing for allergens in and should be to a patient is to use a specific after the of a be to is an exposure of the and a to may the patient to use of the in a Allergic Contact Dermatitis to an used in the and Author Affiliations: of 2Division of Medicine, Department of Medicine, University of Canada Background: and are and A of is as a in a of from personal products to is an by A old as a from to and of a of 4 personal during the and while on the day the patient a severe in for 10 The patient had on previous with no patch testing 6 after showed positive reactions to and and are used for and In the are associated with a risk of the use of The of may have for from Patch on of the Contact Dermatitis Research Group Author Department of and Dermatology, University Hospital, Background: the on the of and at a ratio of have used in and products as as in contact to this has has in as a in at a of Patch testing has with a of and has the with to data show that is the in To study the number of cases with contact to by testing with with testing with and dermatitis patients at were patch with and Results: The number of cases with contact to testing with between in the In of the patients reacted to and not to to the of contact to not by in at is in the from January of a into a with Skin and and are the for and are as the of a to the the with to and showed an for and In the in the of to was a skin of and with an to strong for and risk of the skin of an risk to or are the and of with Contact Dermatitis of the Angela and Author Affiliations: of and School of University of Department of St. Hospital, Canada and Objective: using have the of skin The of this study was to our of the and using Methods: data was with patients with to severe contact were and using on and as as personal and environmental that and of Results: The were the of the difficulty with and to the with to negative and Conclusions: This study that with to severe contact dermatitis severe function, and in and a from and and also with the and from is and Author Affiliations: 1University of College of Medicine, University School of around the to as case have contact dermatitis due to the dermatitis is to be an allergic contact dermatitis from metal and of from has in but not in the To assess exposure to metal were for and using and of were to from at 1 were to While to may be and the for ACD are not In to that products including and also were to in to ACD. in as and and Author Affiliations: University School of Medicine, of College of Hospital, Research Department of University is data of and the and not the use of the including and were in and around in for the that used the or were and were to allergens in the North American Contact Dermatitis Group screening using a into of products at contact and The number of allergens in was The was cocamidopropyl in by and and were The was as an in was in and patients should be of the between and and of a Dermatitis Screening in a and Author Affiliations: School of and Department of Medicine, University of University and St. Hospital, Canada and Objective: are at increased risk of developing skin the of and of not have screening The of the study was to assess the of a dermatitis screening Methods: a screening was and in in an and on The combined by the and of the by or a clinical with those who used the to of and were Results: were to have and to severe The revealed that the was and was to and Conclusions: Dermatitis screening may be and have the to the risk of dermatitis and those at and in and Author Affiliations: Medical College of Medicine, 2Division of has no of in recurring skin and for skin has some patients to in a known and may and in or of and further While case have the results of we a woman of to the biopsy of a with to the in the of a with and are to should be to standard of should be of the associated and the of and should be of this to be to better and treat A to for with Contact Dermatitis I and Author Affiliations: School of Department of and Department of University of and St. Hospital, Canada and Objective: While is on to and that may is for for with skin The of the study was to the and to for patients in at St. and Methods: patients who had to for were and to and for and were used for the Results: case and skin and or a to skin difficulty following skin of or the was not to of between the and with the Conclusions: A with by a from the and in Dermatology from and Author Affiliations: of Dermatology, University of and Objective: To and during an contact dermatitis in Methods: case of cutaneous in the Dermatology Clinic in be Results: A old with dermatitis was patch test positive to and in a at as as in personal A year-old as as an on the of the and was to be test not patch positive to A year-old had severe atopic dermatitis on her with but her dermatitis Patch testing was positive for in her at Conclusions: Contact dermatitis to and is in and and has become in The Series has expanded to include as an on is to between and hypersensitivity on patient patch testing to American Contact Dermatitis Dermatology Skin by Patch for Allergic Contact Dermatitis at the of MD, and Ponciano Cruz Jr, MD Author Affiliations: Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas A year-old underwent by a skin and treated with topical and steroids. a and on and an with around the from and were and not the of the showed Patch testing to the NACDG and steroid (Chemotechnique) negative to and positive to and and positive to of the skin and without and and the to To better the the patient is for patch testing after the eruptions Our case the

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