Journal Scan / Research · August 25, 2022 Hand and Foot Dermatitis in Patients Referred for Patch Testing Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• This retrospective study analyzed the characteristics of and positive allergens in patients with hand dermatitis (HD), foot dermatitis (FD), or hand and foot dermatitis (HFD) who received a patch test between 2001 and 2018. HD was associated with atopic dermatitis, asthma, and hay fever. The rates of HD were high among White patients, whereas the rates of FD were high among Black patients. Allergic reactions to more than one screening allergen occurred in approximately 80% of patients with either HD, FD, and HFD. Patients with HD had more occupationally relevant allergens than those with FD or HFD. Nickel and fragrance mix I were among the top relevant allergens for all three conditions, while the other top allergens varied between the three conditions.

• In patients with HD, it is important to thoroughly review possible occupational exposures. Nickel and fragrance mix I are the top relevant allergens for HD, FD, and HFD.

–  Katherine M. Stiff, MD

Written by

 

 

Christen Maria Mowad MD

Hand dermatitis, foot dermatitis, and dermatitis of both the hands and feet are common diagnosis in the dermatology clinic. There are multiple potential etiologies of these presentations, including allergic contact dermatitis, irritant contact dermatitis, atopic dermatitis, and psoriasis. As a result, patch testing is often conducted to help elucidate the role of allergy in these patients. This study sought to characterize differences in patch test results and demographics of these groups in the patch test setting.

Of the 43,677 patients who were patch tested, 22.8% had hand dermatitis, 2.9% had foot dermatitis, and 3.7% had both hand and foot dermatitis. All three groups had similar allergic and relevant patch test reactions to 1 or more North American Contact Dermatitis Group screening allergens. Currently, relevant patch test reactions occurred in 78.3% of hand dermatitis, 79.3% of foot dermatitis patients, and 76.3% of patients with both hand and foot dermatitis. Participants in all three of these groups were more likely to be male, younger than 40, and employed, when compared to other sites.

The hand dermatitis group had higher proportions (18%) of occupationally relevant reactions, compared with the hand and foot dermatitis group (8.9%) and the foot dermatitis group (4%). Atopic dermatitis was more likely associated with patients with hand and hand and foot dermatitis but not foot dermatitis.   

As for allergens, nickel and fragrance mix I were in the top five currently relevant allergens for all three groups. Nickel sources were jewellery, food, and footwear, depending on the group. When looking specifically at the individual sites, other top hand dermatitis allergens included quaternium-15, benzalkonium chloride, and methylisothiazolinone. Common foot dermatitis allergens included potassium dichromate, 4-tert-butylphenol formaldehyde resin, and Myroxylon pereirae resin. These allergens were often found in footwear, with other sources being cement. Hand and foot dermatitis allergens included M pereire, potassium dichromate, and carba mix, also commonly found in footwear, gloves, and cosmetics.

ACD was the most common final diagnosis (60.8%) in hand dermatitis, followed by foot dermatitis (57.7%) and hand and foot dermatitis (55%). This reminds clinicians to consider patch testing when evaluating patients with hand, foot, or hand and foot dermatitis, as allergy may be the cause or contributing factor in the patient findings. Expanded allergy testing is the standard for identifying causative allergens.

Abstract

BACKGROUND

Dermatitis localized to hands (HD), feet (FD), or both hands and feet (HFD) has multiple etiologies including atopic dermatitis (AD), irritant contact dermatitis (ICD), and allergic contact dermatitis (ACD). Little is known about clinical differences between patients with HD, FD and HFD.

OBJECTIVES

To characterize differences of demographics, etiology, and patch testing results among patients presenting with HD, FD, or HFD referred for patch testing.

METHODS

A retrospective analysis of patients patch tested by the North American Contact Dermatitis Group (NACDG) between 2001-2018.

RESULTS

Of 43,677 patients who were patch tested, 22.8% had HD, 2.9% had FD, and 3.7% had HFD. Allergic and currently relevant patch test reactions to ≥1 NACDG screening allergen occurred in similar proportions in all 3 study groups. However, HD (18.0%) had higher proportions of occupationally relevant reactions than HFD (8.9%) or FD (4.0%). Nickel and fragrance mix I were in the top five currently relevant allergens for HD, FD and HFD. Other top allergens, as well as allergen sources differed between HD, FD and HFD.

LIMITATIONS

No data on HD or FD morphology or distribution.

CONCLUSIONS

HD, FD and HFD have several differences with respect to patient characteristics, etiologies and clinically relevant allergens.

Journal of the American Academy of Dermatology

Hand and foot dermatitis in patients referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2001-2018

J Am Acad Dermatol 2022 Aug 05;[EPub Ahead of Print], JI Silverberg, N Patel, EM Warshaw, JG DeKoven, DV Belsito, AR Atwater, MC Houle, JS Taylor, MJ Reeder, KA Zug, D Sasseville, VA DeLeo, MD Pratt, JF Fowler, HI Maibach 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

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

Please excuse the shortness of this message, as it has been sent from
a mobile device.