Allergic Contact Dermatitis and Patch Testing in Skin of Color Patients

Objective: Skin of color patients face important health issues relevant to dermatologists, such as allergic contact dermatitis; however, there is a lack of information surrounding common allergens causing contact dermatitis that disproportionately affect skin of color patients, as well as interpreting patch testing in this population. Methods: Covidence, Embase, MEDLINE, PubMed, Web of Science, and Google Scholar were searched to identify relevant articles studying allergic and irritant contact dermatitis in skin of color patients. Results: The most common positive reactions in African American patients included PPD, balsam of Peru, bacitracin, fragrance mix, and nickel. The most common positive reactions in Hispanic patients included Carba mix, nickel sulfate, and thiuram mix. The most common positive reactions in Asian patients included nickel sulfate, fragrance mix, and potassium dichromate. When interpreting patch test results in patients with higher Fitzpatrick skin types, positive patch tests presented with lichenification and hyperpigmentation, rather than erythema and vesicles. Furthermore, characteristic bright red or pink hues for positive results may appear violaceous or faint pink. Conclusions: Awareness of the common allergens associated with allergic contact dermatitis in patients of skin of color can help guide patch testing as an important diagnostic tool. Further research must be conducted regarding contact dermatitis in this patient population, especially given the relative lack of data surrounding Hispanic, Asian and Pacific Islander, and Native American patients.

Trends in allergic conditions among children: United States, 1997-2011

Allergic conditions are among the most common medical conditions affecting children in the United States (1-5). An allergic condition is a hypersensitivity disorder in which the immune system reacts to substances in the environment that are normally considered harmless (6,7). Food or digestive allergies, skin allergies (such as eczema), and respiratory allergies (such as hay fever) are the most common allergies among children. Allergies can affect a child's physical and emotional health and can interfere with daily activities, such as sleep, play, and attending school (8,9). A severe allergic reaction with rapid onset, anaphylaxis, can be life threatening. Foods represent the most common cause of anaphylaxis among children and adolescents (10,11). Early detection and appropriate interventions can help to decrease the negative impact of allergies on quality of life (6). This report presents recent trends in the prevalence of allergies and differences by selected sociodemographic characteristics for children under age 18 years.

Quality of life of patients with allergic contact dermatitis: an exploratory analysis by gender, ethnicity, age, and occupation

BACKGROUND

Little has been published regarding the impact of gender, ethnicity, age, and occupation on the quality of life (QoL) of patients with allergic contact dermatitis (ACD).

OBJECTIVES

This study investigated the relationship between QoL scores for patients with ACD and variables such as gender, ethnicity, age, and occupation.

METHODS

Four hundred twenty-eight patients with ACD were mailed a QoL questionnaire modified from Skindex-16 to include an additional five items pertaining to occupational impact. The QoL scores were analyzed to ascertain factors that affect QoL in patients with ACD.

RESULTS

The response rate was 35%. Non-Caucasians reported lower QoL scores than did Caucasians within the functioning scale. There were no statistically significant gender-related differences in QoL scores although females reported a higher degree of emotional distress. Younger subjects were more likely to have lower QoL scores within the functioning and occupational scales. Industrial workers reported the worst occupational QoL, followed by office workers. Occupation was the variable that significantly affected the greatest number of survey subjects, followed by age, ethnicity, and gender.

CONCLUSIONS

Three of the four variables examined had a significant association with QoL. Non-Caucasians, younger subjects, and industrial workers reported a significantly worse QoL due to ACD. There were no statistically significant gender-related differences in QoL scores.

Ethnic skin: overview of structure and function

Racial variability in skin function is an area in which data often conflict. Understanding and quantifying racial differences in skin function are important for skin care and the prevention and treatment of skin diseases. A key feature that characterizes race is skin color: Is deeply pigmented skin different from fair skin in terms of responses to chemical and environmental insults? Is skin care the same? Are there different risks among racial groups of developing a skin disease after exposure to the same insults? The interpretation of pathophysiologic phenomena should consider not only anatomic and functional characteristics of ethnic groups but also socioeconomic, hygienic, and nutritional factors. This article reviews and discusses recent findings.

Population differences in acute skin irritation responses. Race, sex, age, sensitive skin and repeat subject comparisons

The variability in human skin irritation responses has been well documented and can confound our ability to accurately assess differences in skin reactivity between human subpopulations. In the current analysis, results were compiled from nine acute irritation patch test studies, conducted at three test facilities over a 5-year period. Four irritant test chemicals, 20% sodium dodecyl sulphate, 100% decanol, 100% octanoic acid and 10% acetic acid, were tested in sufficient numbers of test subjects to enable the stratification of results for different human subpopulations. An increased reactivity was noted for Asian versus Caucasian subjects for each of three test chemicals, in contrast to the previously described individual study results from which these data were drawn. Male subjects were directionally or significantly more reactive to each of the test chemicals than female subjects. The oldest age cluster of subjects (56-74 years of age) was directionally or significantly less reactive than younger age clusters. There was virtually identical reactivity between self-assessed 'sensitive' and normal skin groups. Lastly, there was little correlation between the results from individual subjects tested in two or more studies with the same chemicals. These results add to our general understanding of population differences in skin reactivity and the potential implications for ingredient and product skin safety testing and risk assessment.

The effect of race and ethnicity on patch test results

BACKGROUND

Allergic contact dermatitis is a condition that may be affected by differences in genetic and environmental factors. Race and ethnicity are possible examples of the former.

OBJECTIVE

The objective of this study was to examine the differences in patch test results between white and black individuals tested by the members of the North American Contact Dermatitis Group from July 1, 1992, to June 30, 1998.

METHODS

Patients evaluated in our patch test clinics were exposed to a standardized patch testing technique involving a standard series of 41 allergens in total. The standard series we used varied over the 6 years of the study in 2-year cycles. The series was the same at all centers during each of these 2-year cycles: 1992-94, 1994-96, and 1996-98. Over a 6-year period, our group tested 9624 patients. Of those individuals, 8610 (89.5%) were white and 1014 (10.5%) were black.

RESULTS

Allergic contact dermatitis and irritant contact dermatitis were the final diagnoses assigned by the investigators to individuals of the 2 races: 49% and 16%, respectively, for the white patients and 46% and 15%, respectively, for the black patients. In at least one of the three 2-year periods, testing in white patients revealed higher rates of sensitization to formaldehyde, glutaraldehyde, and a number of the formaldehyde-releasing preservatives, as well as lanolin, epoxy resin, thioureas, and balsam of Peru. Black patients exhibited higher rates of sensitization to para-phenylenediamine, cobalt chloride, thioureas, and p-tert-butylphenol formaldehyde resin in at least one of the 2-year periods.

CONCLUSION

In this test population, we found no differences in the overall response rate to allergens. There were some differences between white and black patients in their response to specific allergens. These differences, although possibly related to genetic factors based on race, are more likely related to differences in allergen exposure determined by ethnicity.

Comparison of patch test results with a standard series among white and black racial groups

BACKGROUND

Environmental, cultural, occupational, genetic, individual, and racial differences are important factors in the study of contact dermatitis. Some epidemiologic studies have compared overall sensitization rates among different racial groups, but similar data are lacking on individual allergens.

OBJECTIVE

Determine differences in sensitization rates between 2 racial groups in North America undergoing patch testing over a period of 4 years at the Cleveland Clinic Foundation (CCF), Ohio.

METHODS

Retrospective computer review of the standard screening tray results of 991 patients with an average age of 45.9 years consisting of 877 (88.5%) whites and 114 (11.5%) blacks.

RESULTS

Nickel sulfate and thiomersal (both 8.0%) and nickel sulfate and p-phenylenediamine (both 10.6%) were the 2 most common sensitizers among whites and blacks respectively. There was a statistically significant difference (P =.00599) in the sensitization rate for p-phenylenediamine in blacks (10.6%) compared with whites (4.5%). There were also statistically significant differences in sensitization rates for p-phenylenediamine (21.2%; P =.00005) and imidazolidinyl urea in petrolatum (pet.) (9.1%; P =.04103) in black men compared with white men (p-phenylenediamine [4.2%] and imidazolidinyl urea [2.6% pet.]).

CONCLUSION

The differences in sensitization rates, especially for p-phenylenediamine, may reflect variations in allergen exposure among racial groups or interindividual variations in the N-acetylation (N-acetyltransferase 1 [NAT1] and 2 [NAT2]) capacities of human skin for p-phenylenediamine.