Cutaneous delayed-type hypersensitivity in patients with atopic dermatitis: reactivity to topical preservatives.
BACKGROUND
Patients with atopic dermatitis (AD) have chronic dry skin to which they frequently apply skin care products containing preservatives, and they are predisposed to developing cutaneous delayed-type hypersensitivity.


OBJECTIVE
We sought to compare the rates of positive patch test reactions to allergens on the North American Contact Dermatitis Group (NACDG) standard tray among patients with and without AD and to assess whether atopic patients in our database were more likely to patch test positive to preservatives.


METHODS
A total of 2453 patients underwent patch testing to the NACDG standard screening series. The incidence of positive patch test reaction among patients with AD (n = 342) and without AD (n = 2111) was assessed. Statistical analysis was done using a χ(2) test.


RESULTS
Compared with nonatopic patients, patients with AD were statistically more likely to have positive patch tests. AD was associated with contact hypersensitivity to quaternium-15, imidazolidinyl urea, DMDM hydantoin, and 2-bromo-2-nitropropane-1,3-diol but not to parabens, formaldehyde, or diazolidinyl urea.


CONCLUSIONS
Only patients suspected of having allergic contact dermatitis were tested. Our population was geographically limited to metropolitan Kansas City, MO, and metropolitan New York City, NY.


CONCLUSIONS
Patients with AD should avoid the use of skin care products preserved with formaldehyde releasers.
University of Louisville School of Medicine, Louisville, Kentucky.
Cristin N
CN
Shaughnessy
Columbia University College of Physicians and Surgeons, New York, New York.
Dana
D
Malajian
Department of Dermatology, Columbia University Medical Center, New York, New York. Electronic address: dvb2108@columbia.edu.
Donald V
DV
Belsito
D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology*; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000453:epidemiology; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006827:Hydantoins / Q000009:adverse effects / Q000276:immunology; D015994:Incidence; D008297:Male; D008709:Methenamine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000276:immunology; D010328:Patch Tests; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects*; D011409:Propylene Glycols / Q000009:adverse effects / Q000276:immunology; D012737:Sex Factors; D014508:Urea / Q000009:adverse effects / Q000031:analogs & derivatives / Q000276:immunology
D003879:Dermatologic Agents; D006827:Hydantoins; D011310:Preservatives, Pharmaceutical; D011409:Propylene Glycols; C006827:bronopol; D014508:Urea; C056057:1,3-dimethylol-5,5-dimethylhydantoin; C018375:quaternium-15; D008709:Methenamine; C006048:imidazolidinyl urea
AD; CDTH; NACDG; North American Contact Dermatitis Group; allergy; atopic dermatitis; atopic eczema; cutaneous delayed-type hypersensitivity; formaldehyde releasers; hypersensitivity; patch testing; preservatives