Contact dermatitis, generally defined as an inflammation of the skin, results from exposure to an external agent and is most often classified as irritant contact dermatitis (ICD) or allergic contact dermatitis (ACD) (Tan et al. Clin Dermatol 32(1):116–124, 2014). Considerable overlap exists between the two conditions in clinical, histological, and molecular presentation, while the two may also coexist (Taylor and Amado. Contact dermatitis and related conditions. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/contact-dermatitis-and-related-conditions/. Accessed 25 Oct 2017, 2010; Lachapelle and Maibach 2012).
A thorough history and physical exam may lead to diagnosis in select cases such as nickel or poison ivy allergy; however, distinction between ACD and ICD is best accomplished through patch testing. Patch testing is an attempt to reproduce the eczematous reaction of ACD on a smaller scale by applying a collection of allergens under occlusion at nonirritating concentrations on intact skin of the affected patient (Mowad et al. J Am Acad Dermatol 74(6):1029–1054, 2016). The clinician must be mindful of the varying patch testing materials and methods, procedural details, patch test reading and scoring, and various patch testing side effects. In treating ACD, the primary focus is avoidance of the allergen with several strategies and supplementary treatment options discussed in the following chapter.
KeywordsAllergen Allergic contact dermatitis Irritant Irritant contact dermatitis Patch testing
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