The clinical epidemiology of allergic contact dermatitis

Abstract

Background: Allergic contact dermatitis (ACD) is a common dermatologic diagnosis affecting over 13million patients annually in the United States. Despite its prevalence, limited research has been conducted regarding its clinical epidemiology. The development of contact dermatitis can vary based on genetics, environmental exposures, and co-morbidities such as atopic dermatitis (AD). This project examined the relationship of sex, race, age, and socioeconomic status with the risk of developing allergic contact dermatitis. A secondary goal of this project was to determine the predictors of and relevant allergens in ACD among patients with AD.Materials: We performed a retrospective chart review of 395 adults who were patch-tested at the Northwestern Medicine patch-testing clinic from 2014-2017. Patients were patch-tested with the North American Contact Dermatitis Group (NACDG) standard series and a supplemental allergen series. Demographic data such as sex, age, race, insurance,birthplace, and zip code (as a surrogate for income) were collected. Chi square tests and multivariable logistic regression models were used to estimate adjusted odds ratio and 95% confidence intervals.Results: There were no associations between sex, age, race, insurance, birthplace and the development of ACD. However, individuals estimated to be making less than the median income had an increased risk of developing allergic contact dermatitis (adjustedodds ratio [95% confidence interval] (3.50 [1.36 9.02]). AD patients (n=97) had significantly higher rates of positive patch test reactions to ingredients in their personal care products or topical medicaments, including lanolin (P=0.03), quaternium-15 (P=0.04), fragrance mix I (P=0.008), cinnamal (P=0.02), neomycin (P=0.02), bacitracin (P=0.04), chlorhexidine (P=0.04), and budesonide (P=0.01).Conclusions: Low income was the only demographic factor found to be associated with the development of ACD. Patients with AD did not have higher rates of positive patch test reactions overall. However, they had higher rates of positive patch test reactions tomultiple ingredients in their personal care products and topical steroid and antibiotic medicaments. Future research is needed to understand the risk factors associated with ACD to better predict and prevent this burdensome disease.

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