title: Cutaneous delayed-type hypersensitivity in patients with atopic dermatitis: reactivity to surfactants.
abstract: BACKGROUND
  Patients with atopic dermatitis (AD) have abnormalities in skin barrier function, and are predisposed to developing cutaneous delayed-type hypersensitivity. Soap and detergents are known to exacerbate the breakdown of the skin barrier.
  
  
  OBJECTIVE
  We sought to assess whether atopic patients in our database were more likely than nonatopic patients to patch test positive to the surfactants cocamidopropyl betaine (CAPB) and cocamide diethanolamide (DEA), or to the surfactant precursor amidoamine.
  
  
  METHODS
  Between January 1, 2001, and the present, a total of 1674 patients underwent patch testing to the North American Contact Dermatitis Group standard screening series. The incidence of positive patch test results to CAPB, cocamide DEA, and amidoamine among patients with AD (n = 242) and without AD (n = 1422) was assessed. Statistical analysis was done using a χ(2) test.
  
  
  RESULTS
  AD was associated with contact hypersensitivity to CAPB, but not to cocamide DEA or amidoamine.
  
  
  CONCLUSIONS
  This was a retrospective study of patients evaluated for suspected allergic contact dermatitis and, therefore, matching for gender, age, or other parameters was not possible. 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 skincare products containing the surfactant CAPB.
authors: University of Louisville School of Medicine, Louisville, Kentucky.
authors: Cristin N
authors: CN
authors: Shaughnessy
authors: Columbia University College of Physicians and Surgeons, New York, New York.
authors: Dana
authors: D
authors: Malajian
authors: Department of Dermatology, Columbia University Medical Center, New York, New York. Electronic address: dvb2108@columbia.edu.
authors: Donald V
authors: DV
authors: Belsito
mesh_terms: D000328:Adult; D000368:Aged; D001622:Betaine / Q000031:analogs & derivatives* / Q000276:immunology; D015331:Cohort Studies; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013501:Surface-Active Agents / Q000009:adverse effects; D055815:Young Adult
chemical_list: D013501:Surface-Active Agents; D001622:Betaine; C077055:cocamidopropyl betaine
keywords: allergy; atopic eczema; cocamidopropyl betaine; hypersensitivity; patch testing; surfactants