Pantomima ayuda al diagnóstico de la dermatitis de contacto.

Published in Dermatology

Journal Scan / Case Study · February 05, 2020

The Value of Pantomiming for Allergic Contact Dermatitis

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• In this brief commentary, the authors discuss pantomiming as a useful tool in evaluating a patient with suspected allergic contact dermatitis. Pantomiming, in which the patient mimics actions he or she would usually perform with objects not present, can be prompted by asking the patient to pretend to be using the object or to show how an object is used. The authors present three brief cases demonstrating its use in understanding the pattern of rash, guiding selection of allergens, or identifying a relevant source of an allergen.

• Pantomiming is a simple diagnostic tool which will improve the clinical repertoire of dermatologists seeing patients with suspected allergic contact dermatitis.

– Margaret Hammond, MD

Written by

 

 

Susan T Nedorost MD

This case series describes the utility of pantomime when assessing dermatitis. Dermatologists should note the distribution of dermatitis in great detail. Dermatitis can be treated with better precision after patch testing for allergic contact dermatitis.

We must also document the distribution of exposure of contactants in order to select all potential allergens for patch testing. Failure to test the culprit allergen will result in diagnostic failure.

Patients can more accurately demonstrate the way they apply personal care products or medicaments, hold items such as their key ring, and handle tools at work if they are asked to pantomime, rather than describe, these activities.

We must also eliminate allergens that cannot explain the distribution of dermatitis in order to maximize value of testing. Patients may pantomime skin contact with suspected contactants in sensitive areas, such as the face, that never develop dermatitis, thus reducing the number of potential allergens that must be tested.

Pantomime can also help patients understand the distribution of dermatitis that does not require patch testing. Poison ivy dermatitis often occurs near the waistline where hands contaminated with the resin are used to pull down clothing when using the restroom. Asking patients to pantomime this motion generally corresponds to distribution of plant dermatitis on the abdomen.

Pantomime is useful in most consultations when planning diagnosis and treatment of dermatitis.

Abstract

Pantomiming enables humans to communicate in a context in which the tools of references are not physically present through mimicry.1,2 Pantomime in dermatology is useful to help understand the pattern of allergic contact dermatitis (ACD). Alstroemeria, the Peruvian lily, is a well-documented occupational allergen for florists (Figure 1).3 This distribution is clarified as a florist pantomimes hand placement on the flower to strip the stem.3 Garlic is another well-recognized cause of ACD in which pantomime can help explain the distribution involving the non-dominant thumb and index finger that holds the garlic as the dominant hand cuts it (Figure 2).4 We present three cases where pantomime was useful in diagnosing ACD.

Journal of the American Academy of Dermatology

The Value of Pantomiming for Allergic Contact Dermatitis

J Am Acad Dermatol 2020 Jan 18;[EPub Ahead of Print], P Kamrani, S Nedorost 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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